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WO2023076281A1 - Compositions orales et nasales et méthodes de traitement - Google Patents

Compositions orales et nasales et méthodes de traitement Download PDF

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Publication number
WO2023076281A1
WO2023076281A1 PCT/US2022/047741 US2022047741W WO2023076281A1 WO 2023076281 A1 WO2023076281 A1 WO 2023076281A1 US 2022047741 W US2022047741 W US 2022047741W WO 2023076281 A1 WO2023076281 A1 WO 2023076281A1
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Prior art keywords
dose
commercially available
hydrochloride
diazepam
administered
Prior art date
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Ceased
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Inventor
Stephen Paul Wargacki
Alexander Mark Schobel
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Aquestive Therapeutics Inc
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Aquestive Therapeutics Inc
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Priority to EP22888070.4A priority Critical patent/EP4422607A4/fr
Publication of WO2023076281A1 publication Critical patent/WO2023076281A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0043—Nose
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
    • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
    • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
    • A61K31/5517—1,4-Benzodiazepines, e.g. diazepam or clozapine condensed with five-membered rings having nitrogen as a ring hetero atom, e.g. imidazobenzodiazepines, triazolam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A61K9/006—Oral mucosa, e.g. mucoadhesive forms, sublingual droplets; Buccal patches or films; Buccal sprays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/70—Web, sheet or filament bases ; Films; Fibres of the matrix type containing drug
    • A61K9/7007—Drug-containing films, membranes or sheets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/08—Antiepileptics; Anticonvulsants

Definitions

  • This invention relates to pharmaceutical compositions and methods of treatment.
  • a seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behavior, movements or feelings, and in levels of consciousness. If two or more seizures or a tendency for recurrent seizures occurs, a subject is often diagnosed with epilepsy.
  • Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.
  • Benzodiazepines are often used to treat medical conditions such as seizures, anxiety, insomnia, alcohol withdrawal, and amnesia. They can be used as a muscle relaxant. They are sometimes provided before an anesthetic, such as before surgery.
  • benzodiazepines are alprazolam (Xanax), lorazepam (Ativan), chlordiazepoxide (Librium), and diazepam (Valium).
  • Benzodiazepines can be used to treat CNS (central nervous system) disorders.
  • a method of administering diazepam with a multimodal delivery profile can include delivering diazepam from a matrix, and promoting permeation of at least a portion of the diazepam through a mucosal tissue.
  • the delivery can result in an unexpected, surprising food effect.
  • a method of administering a benzodiazepine drug to a subject can include administering an effective dose of a pharmaceutical formulation including a benzodiazepine drug to the subject as a spray, the effective dose of the benzodiazepine drug being at least 5% higher than a non-fed state effective dose for the patient.
  • a method of administering a benzodiazepine drug to a subject can include administering a first effective dose of a pharmaceutical formulation including a benzodiazepine drug to the subject as a first nasal spray and, within 4 hours or less, administering a second effective dose of the benzodiazepine drug as a second nasal spray.
  • a method of administering a benzodiazepine drug to a subject can include administering a first dose of a pharmaceutical formulation including a benzodiazepine drug to a nasal cavity of the subject, and evaluating a therapeutic effect in the subject, and, if a therapeutic effect is not experienced by the subject within 4 hours or less of the first dose, administering a second dose of the pharmaceutical formulation including the benzodiazepine drug to the nasal cavity of the subject.
  • a method of administering a benzodiazepine drug to a subject can include administering an effective dose of a pharmaceutical formulation including a benzodiazepine drug to the subject as a spray, wherein the effective dose of the pharmaceutical formulation includes delivering a first dose and a second dose, if the first dose does not produce a therapeutic effect in the subject, to the subject, at least one of the first dose and the second dose being greater than 0.20 mg/kg.
  • administering a benzodiazepine can include delivering the pharmaceutical formulation to an oral cavity.
  • administering a benzodiazepine drug can include delivering the pharmaceutical formulation to a nasal cavity.
  • the concentration of the administered benzodiazepine drug can be at least 5% higher than a non-fed state effective dose for the patient.
  • the concentration of the administered benzodiazepine drug can be at least 8% higher than a non-fed state effective dose for the patient.
  • the concentration of the administered benzodiazepine drug can be at least 10% higher than a non-fed state effective dose for the patient.
  • the concentration of the administered benzodiazepine drug can be at least 20% higher than a non-fed state effective dose for the patient.
  • the concentration of the administered benzodiazepine drug can be at least 25% higher than a non-fed state effective dose for the patient. In certain embodiments, the concentration of the administered benzodiazepine drug can be at least 50% higher than a non-fed state effective dose for the patient.
  • the concentration of the administered benzodiazepine drug can be at least 60% higher than a non-fed state effective dose for the patient.
  • administering can include spraying a first dose in one or more nostrils of the subject.
  • the pharmaceutical formulation has a therapeutic window of 45 minutes or less. In certain embodiments, the pharmaceutical formulation has a therapeutic window of 30 minutes or less. In certain embodiments, the pharmaceutical formulation has a therapeutic window of 15 minutes or less.
  • the pharmaceutical formulation has a therapeutic window of 10 minutes or less.
  • the pharmaceutical formulation can have a therapeutic window of 5 minutes or less.
  • the pharmaceutical formulation is administered as a first effective dose and a second effective dose
  • the first dose can be administered as a nasal spray
  • the second dose can be administered as a nasal spray.
  • the first dose and the second dose together contain the concentration of the benzodiazepine drug that is higher than a non-fed state effective dose for the subject.
  • the concentration of the benzodiazepine drug is at least 5% higher than the non-fed state effective dose for the subject.
  • the first and second dose together contain a concentration of the benzodiazepine drug at least 5% higher that the non-fed state effective dose for the subject.
  • the first and second dose together contain a concentration of the benzodiazepine at least 10% higher that the non-fed state effective dose for the subject.
  • the first and second dose together can also contain a concentration of the benzodiazepine at least 15% higher than a non-fed state effective dose for the subject.
  • the first dose can contain a concentration of the benzodiazepine drug that is at least 40% higher than a non-fed state effective dose for the subject.
  • administering can include spraying a second dose in one or more nostrils of the subject.
  • the effective dose of the pharmaceutical formulation includes delivering a second dose after a first dose.
  • the second dose is administered within 4 hours or less of the first dose. In certain embodiments, the second dose is administered within 2 hours or less of the first dose. In certain embodiments, the second dose is administered within 1 hour or less of the first dose. In certain embodiments, the second dose is administered within 30 minutes of less of the first dose. In certain embodiments, the second dose is administered within 10 minutes or less of the first dose.
  • the first dose or the second dose can be 60% of a minimum therapeutic dose in a fed state, 70% of a minimum therapeutic dose in a fed state, or 80% of a minimum therapeutic dose in a fed state.
  • each of the first dose and the second dose can be 5 mg for a subject 6 to 11 years of age and 10 kg to 18 kg or a subject 12 years of age and older and 14 kg to 27 kg. In certain embodiments, each of the first dose and the second dose can be 10 mg for a subject 6 to 11 years of age and 19 kg to 37 kg or a subject 12 years of age and older and 28 kg to 50 kg. In certain embodiments, each of the first dose and second dose can be 15 mg for a subject 6 to 11 years of age and 38 kg to 55 kg or a subject 12 years of age and older and 51 kg to 75 kg. In certain embodiments, each of the first dose and second dose can be 20 mg for a subject 6 to 11 years of age and 56 kg to 74 kg or a subject 12 years of age and older and 76 kg and up.
  • the first dose and the second dose together can contain the concentration of the benzodiazepine drug that is higher than a recommended effective dose for the subject.
  • administering the first dose and administering the second dose can meet or exceed a recommended effective dose for the subject.
  • administering the benzodiazepine drug can achieve a therapeutic threshold of 45 minutes or less or of 15 minutes or less.
  • both the first dose and the second dose can be greater than 0.30 mg/kg.
  • administering the first dose and the second dose together contain the concentration of the benzodiazepine drug that can be at least 40% higher than a non-fed state effective dose for the subject.
  • the pharmaceutical formulation can include a rheological modifying agent.
  • the pharmaceutical formulation can include a thixotropic agent.
  • benzodiazepine drug can be alprazolam, brotizolam, chlordiazepoxide, clobazam, clonazepam, clorazepam, demoxazepam, diazepam, flumazenil, flurazepam, halazepam, midazolam, nordazepam, medazepam, nitrazepam, oxazepam, lorazepam, prazepam, quazepam, triazolam, temazepam, loprazolam, or any pharmaceutically- acceptable salts thereof, and any combinations thereof.
  • the benzodiazepine drug can be diazepam, or a pharmaceutically-acceptable salt thereof.
  • the diazepam is administered in a fed state.
  • administering a benzodiazepine drug further includes adjusting a dose of diazepam to compensate for a food effect such that a subject will achieve a safe and efficacious dose in a fed state.
  • the diazepam is administered in a fasted state.
  • a single dose can be one dosing in one nostril or two dosings in one nostril or one or more dosings in each nostril.
  • about 1 mg of diazepam can be delivered in a single dose.
  • about 1.25 mg of diazepam can be delivered in a single dose.
  • about 1.5 mg of diazepam can be delivered in a single dose.
  • about 1.75 mg of diazepam can be delivered in a single dose.
  • about 2 mg of diazepam can be delivered in a single dose.
  • about 2.25 mg of diazepam can be delivered in a single dose.
  • about 2.5 mg of diazepam can be delivered in a single dose.
  • about 2.75 mg of diazepam can be delivered in a single dose.
  • about 3 mg of diazepam can be delivered in a single dose.
  • about 3.25 mg of diazepam can be delivered in a single dose.
  • about 3.5 mg of diazepam can be delivered in a single dose. In certain embodiments, about 3.75 mg of diazepam can be delivered in a single dose.
  • about 4 mg of diazepam can be delivered in a single dose.
  • about 4.25 mg of diazepam can be delivered in a single dose.
  • about 4.5 mg of diazepam can be delivered in a single dose.
  • about 4.75 mg of diazepam can be delivered in a single dose.
  • about 5 mg of diazepam can be delivered in a single dose.
  • about 5.25 mg of diazepam can be delivered in a single dose.
  • about 5.5 mg of diazepam can be delivered in a single dose.
  • about 5.75 mg of diazepam can be delivered in a single dose.
  • about 6 mg of diazepam can be delivered in a single dose.
  • about 6.25 mg of diazepam can be delivered in a single dose.
  • about 6.5 mg of diazepam can be delivered in a single dose.
  • about 6.75 mg of diazepam can be delivered in a single dose.
  • about 7 mg of diazepam can be delivered in a single dose.
  • about 7.25 mg of diazepam can be delivered in a single dose.
  • about 7.5 mg of diazepam can be delivered in a single dose.
  • about 7.75 mg of diazepam can be delivered in a single dose. In certain embodiments, about 8 mg of diazepam is delivered in a single dose.
  • about 9 mg of diazepam can be delivered in a single dose.
  • about 10 mg of diazepam can be delivered in a single dose.
  • about 14 mg of diazepam can be delivered in a single dose.
  • about 18 mg of diazepam can be delivered in a single dose.
  • about 20 mg of diazepam can be delivered in a single dose.
  • about 25 mg of diazepam can be delivered in a single dose.
  • about 28 mg of diazepam is delivered in a single dose.
  • about 30 mg of diazepam can be delivered in a single dose.
  • about 36 mg of diazepam can be delivered in a single dose.
  • about 40 mg of diazepam can be delivered in a single dose.
  • a dose of diazepam can be administered according to a weightbased regimen.
  • diazepam can be administered as a rescue medication. In certain embodiments, diazepam can be administered to treat a CNS disorder.
  • diazepam can be administered to treat seizures.
  • diazepam can be administered to treat acute repetitive seizures.
  • diazepam can be administered to treat generalized seizures.
  • diazepam can be administered to treat focal seizures.
  • diazepam can be administered to treat focal aware seizures.
  • diazepam can be administered to treat focal aware impaired seizures.
  • diazepam can be administered to treat bilateral tonic seizures.
  • diazepam can be administered to treat absence seizures.
  • diazepam can be administered to treat atypical absence seizures.
  • diazepam can be administered to treat tonic-clonic seizures.
  • diazepam can be administered to treat atonic seizures.
  • diazepam can be is administered to treat clonic seizures.
  • diazepam can be administered to treat tonic seizures.
  • diazepam can be administered to treat myoclonic seizures.
  • diazepam can be administered to treat gelastic and dacrystic seizures.
  • diazepam can be administered to treat febrile seizures.
  • diazepam can be administered to treat non-epileptic seizures.
  • diazepam can be administered to treat refractory seizures.
  • the pharmaceutical formulation can include an alcohol.
  • the pharmaceutical formulation can include ethanol.
  • the pharmaceutical formulation can include benzyl alcohol.
  • the pharmaceutical formulation can include a natural or synthetic tocopherol or tocotrienol.
  • the pharmaceutical formulation can include vitamin E or a salt of Vitamin E.
  • the pharmaceutical formulation can include an alkyl glycoside.
  • the pharmaceutical formulation can include dodecyl maltoside.
  • the treatment can achieve bioavailability that is from about 40 to 150 % of that achieved with the same benzodiazepine administered intravenously.
  • a method of treating a medical condition can include administering a benzodiazepine drug with a delivery profile comprising delivering benzodiazepine drug to achieve an effective linear average AUC and average Cmax up to about 4 hours.
  • the benzodiazepine drug can be delivered via at least a mucosal route.
  • the benzodiazepine drug can be delivered via at least a transmucosal route.
  • benzodiazepine drug can be delivered via at least a gastrointestinal route.
  • the benzodiazepine drug can be delivered via at least a pharyngeal or transpharyngeal route.
  • the benzodiazepine drug can be delivered via at least an esophageal or transesophogeal route.
  • Fig. 1A shows dose-proportional pharmacokinetics of diazepam buccal film (DBF) in healthy adult males in which plasma diazepam concentrations were measured in a single-dose, randomized, open-label, three-period, crossover study of diazepam buccal film (DBF) 5 mg, 10 mg, and 15 mg in 30 healthy adult male volunteers under fasting conditions.
  • DPF diazepam buccal film
  • Fig. IB shows the same study as Fig. 1A for plasma diazepam concentrations measured as a function of time.
  • Fig. 1C shows a comparison of diazepam buccal film vs. diazepam rectal gel in Cmax as a function of nominal dose.
  • Fig. 2 shows a dose proportionality study that was performed across a 5mg, lOmg and 15mg range for diazepam buccal film.
  • Fig. 3 shows a pivotal study comparing one DBF dose (15mg) against three doses (5mg, 12.5mg, and 20mg) of the rectal gel.
  • Fig. 4A shows a study measuring AUC as a function of dose of Diastat®.
  • Fig. 4B shows a study measuring AUC (dose normalized) as a function of dose of Diastat®.
  • Fig. 5 shows a food effect study that was performed under fed and fasted conditions.
  • Fig. 6 shows mean plasma diazepam concentrations in a food effect study comparing fasted upright, fasted reclining, high fat reclining, and moderate fat reclining subjects.
  • Fig. 9 shows a food effect study that was performed under fed and fasted conditions for a spray delivery of diazepam.
  • Seizure clusters occur in many patients with epilepsy, despite treatment with antiepilepsy medications. Available treatment options remain limited.
  • Benzodiazepines including diazepam and midazolam, are the mainstay of treatment for seizure emergencies, including acute repetitive seizures.
  • Non-parenteral dosage forms are used when parenteral (intravenous or intramuscular) dosing is not feasible.
  • Currently available non-parenteral dosage forms have limitations in terms of usability, accuracy of dosing, irritation potential, patient and caregiver acceptance, speed of action, and portability.
  • Benzodiazepines can produce toxic effects and can be intentionally or accidentally taken in overdose. Accordingly, a dosing regimen that allows for improved dosing and control, compliance, speed of action, accountability and usability would supply a critical and yet unmet need.
  • a gel formulation of diazepam intended for rectal administration (e.g., Diastat® Rectal Gel) is administered for certain patients with epilepsy.
  • the drug is administered to patients who require occasional use of diazepam to control bouts of increased seizure activity.
  • Common side effects of this medication include somnolence, sleepiness or drowsiness.
  • Other side effects include dizziness, headache, pain, abdominal pain, nervousness, vasodilation, diarrhea, ataxia or incoordination, euphoria, asthma, rhinitis (irritation of the nose similar to an allergy or a cold) and rash.
  • Diazepam and other currently available products for the treatment of ARS and acute convulsive seizures have significant limitations.
  • Rectal administration is unwieldy, may be embarrassing for patients and caregivers, and use may be restricted by social and legal constraints, and intranasal administration is often poorly accepted by patients due to inaccurate dosing and nasal irritation, which can negatively impact compliance.
  • Most oral tablet forms of benzodiazepines such as lorazepam, diazepam and clonazepam must be swallowed with water and this is only feasible when the patient is awake and alert.
  • Some sublingual or buccal dosage forms may also require patient cooperation depending on the properties of the pharmaceutical composition. Lorazepam in an orodispersible tablet form (Temesta Expidet®) which has been used sublingually in the treatment of acute seizures in children but it and other available oral dosage forms may not act as rapidly as rectal diazepam.
  • ARS also commonly referred to as seizure clusters or seizure flurries, represents a series of seizures grouped consecutively, typically with short (or shorter than usual) interictal periods. More generally, ARS can be considered a change in frequency of seizures for which treatment is desired.
  • ARS neurodegenerative disease 2019
  • ARS neurodegenerative disease 2019
  • parenteral (intravenous or intramuscular) dosing is preferred for seizure rescue therapy, particularly in the emergency treatment of status epilepticus.
  • Alternative non-parental dosage forms are used when parenteral therapy is not feasible or when a patient has such frequent episodes that parenteral therapy is not practical.
  • the objective of therapy may be to prevent seizure recurrence, interrupt progression of a sequence of seizures, or terminate an ongoing seizure.
  • Spray drug delivery is an alternative method of systemic drug delivery that offers several advantages over both injectable, rectal and enteral methods of administration. For some drugs, this results in rapid onset of action via a more comfortable and convenient delivery route than the intravenous route.
  • the spray delivery mode was surprising in that the drug delivery takes place through modes other than the nasal mucosa. Rather than the expected delivery through the nasal mucosa, the delivery occurred exhibits an unexpected food effect. As a result dosing of the active must be altered to achieve appropriate biodelivery. When the multiple delivery modes are not considered, the subject will be under-dosed with active, leading to decreased efficacy.
  • a benzodiazepine drug can be administered to treat a CNS disorder, seizures, acute repetitive seizures, or generalized seizures.
  • a pharmaceutical formulation includes a benzodiazepine drug and an alcohol.
  • a pharmaceutical formulation includes a benzodiazepine drug and an ethanol, a benzyl alcohol, or a natural or synthetic tocopherol or tocotrienol.
  • a pharmaceutical formulation includes a benzodiazepine drug and an alkyl glycoside.
  • a therapeutic effect means a biological response.
  • a therapeutic effect may be induced by a pharmaceutical composition.
  • a therapeutic effect may be evaluated for its ability to treat a medical condition and/or reduce the symptoms of a medical condition, for example, one or more of a reduction in the severity of the seizure, general relaxation of the muscles, reduction in seizure-induced anxiety experienced by the subject, a impartation of a feeling of well-being to the patient, reduction in the duration of the seizure, and reduction in the probability that the patient will experience a repeat seizure, an increase in the interval between the current seizure and the next seizure.
  • a method of administering a benzodiazepine drug to a subject includes administering a first dose of a pharmaceutical formulation including a benzodiazepine drug to a nasal cavity of the subject and, evaluating a therapeutic effect, such as for example, a lack of recurrent seizures in the subject; and if a therapeutic effect is not experienced by the subject within 4 hours or less of the first dose, administering a second dose of the pharmaceutical formulation including the benzodiazepine drug to the nasal cavity of the subject.
  • a method of administering a benzodiazepine drug to a subject can include administering a first dose of a pharmaceutical formulation including a benzodiazepine drug to a nasal cavity of the subject and, within 4 hours or less of the first dose, administering a second dose of the pharmaceutical formulation including the benzodiazepine drug to the nasal cavity of the subject.
  • at least one of the first dose and the second dose can be greater than 0.20 mg/kg.
  • the effective dose is administered in a fed state.
  • the effective dose is administered in a fasted state.
  • at least one of the first and/or second dose is greater than 0.22 mg/kg.
  • At least one of the first and/or second dose is greater than 0.22 mg/kg. In certain embodiments, at least one of the first and/or second dose is greater than 0.24 mg/kg. In certain embodiments, at least one of the first and/or second dose is greater than 0.26 mg/kg. In certain embodiments, at least one of the first and/or second dose is greater than 0.28 mg/kg. In certain embodiments, at least one of the first and/or second dose is greater than 0.30 mg/kg. In certain embodiments, both the first effective dose and the second dose are greater than 0.20 mg/kg.
  • the first dose or the second dose is 60% of a minimum therapeutic dose in a fed state. In certain embodiments, the first dose or the second dose is 70% of a minimum therapeutic dose in a fed state. In certain embodiments, the first dose or the second dose is 80% of a minimum therapeutic dose in a fed state.
  • each of the first dose and the second dose is 5 mg for a subject 6 to 11 years of age and 10 kg to 18 kg or a subject 12 years of age and older and 14 kg to 27 kg. In certain embodiments, each of the first dose and the second dose is 10 mg for a subject 6 to 11 years of age and 19 kg to 37 kg or a subject 12 years of age and older and 28 kg to 50 kg. In certain embodiments, each of the first dose and second dose is 15 mg for a subject 6 to 11 years of age and 38 kg to 55 kg or a subject 12 years of age and older and 51 kg to 75 kg. In certain embodiments, each of the first dose and second dose is 20 mg for a subject 6 to 11 years of age and 56 kg to 74 kg or a subject 12 years of age and older and 76 kg and up.
  • administering the first dose to the nasal cavity of the subject includes spraying the first dose in one or more nostrils of the subject.
  • administering the second dose to a nasal cavity includes spraying the second dose in one or more nostrils of the subject.
  • administering the first dose to a nasal cavity includes spraying the first dose in a nostril of the subject and administering the second dose to a nasal cavity includes spraying the second dose in the nostril of the subject.
  • administering the first dose to a nasal cavity includes spraying the first dose in a first nostril of the subject and administering the second dose to a nasal cavity includes spraying the second dose in a second nostril of the subject.
  • the first dose and the second dose together contain the concentration of the benzodiazepine drug that is higher than a recommended effective dose for the subject.
  • administering the first dose and administering the second dose meets or exceeds a recommended effective dose for the subject.
  • administering the benzodiazepine drug achieves a therapeutic threshold of 45 minutes or less. In certain embodiments, administering the benzodiazepine drug achieves a therapeutic threshold of 15 minutes or less.
  • the second dose is administered within 2 hours or less of the first dose. In certain embodiments, the second dose is administered within 1 hour or less of the first dose. In certain embodiments, the second dose is administered within 30 minutes or less of the first dose. In certain embodiments, the second dose is administered within 10 minutes or less of the first dose.
  • the benzodiazepine drug is diazepam, or a pharmaceutically- acceptable salt thereof. In certain embodiments, a portion of the benzodiazepine drug is delivered via at least an esophageal or pharyngeal route. In certain embodiments, each dose of the benzodiazepine drug is administered according to a weight-based regimen. In certain embodiments, the benzodiazepine drug is administered as a rescue medication. In certain embodiments, the benzodiazepine drug is administered to treat a CNS disorder, seizures, acute repetitive seizures, or generalized seizures. In certain embodiments, the pharmaceutical formulation includes an alcohol. In certain embodiments, erein the pharmaceutical formulation includes ethanol, benzyl alcohol, or a natural or synthetic tocopherol or tocotrienol. In certain embodiments, the pharmaceutical formulation includes an alkyl glycoside.
  • a method of administering a benzodiazepine drug to a subject includes administering an effective dose of a pharmaceutical formulation including a benzodiazepine drug to the subject as a spray, wherein the effective dose of the pharmaceutical formulation includes delivering a first dose and a second dose, if the first dose does not produce a therapeutic effect in the subject, to the subject, at least one of the first dose and the second dose being greater than 0.20 mg/kg. In certain embodiments, both the first dose and the second dose are greater than 0.30 mg/kg.
  • the benzodiazepine drug can be delivered via at least a gastrointestinal route.
  • the benzodiazepine drug can also be delivered via at least a pharyngeal route.
  • Such delivery includes the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs). This mode of delivery can result in rapid drug uptake.
  • the benzodiazepine drug is delivered via at least a esophageal route. This delivery includes the esophagus, a muscular tube connecting the throat (pharynx) with the stomach. Dosage forms that adhere to the esophageal mucosa and prolong contact have been investigated to improve the efficacy of locally acting agents. These modes of delivery can also result in rapid drug uptake, a large surface area for solute transport, improved drug bioavailability, and noninvasive manner of administering the drug.
  • the ratio of fed/fasted was 0.4 or greater, resulting in a consistent Cmax reduction and a Tmax extension.
  • the Cmax reduction can be about 10%, 20%, 30%, 40% or 50%.
  • the Tmax range can be extended by about 20%, 30%, 40%, 50%. ,60%, 80%, 100%, 120%, 140%, or 160%.
  • the absorption of active through composition-mucosal contact may be 100%.
  • the absorption through composition-mucosal contact may be less than 100%.
  • the absorption through the oral or nasal mucosa can be approximately less than 90%.
  • the absorption through the oral or nasal mucosa can be approximately greater than 10%, greater than 20%, greater than 30%, greater than 40%, greater than 50%, greater than 60%, greater than 70%, greater than 80%, or greater than 90%.
  • the composition can include a solvent.
  • the solvent can be amenable to application to a mucosal membrane.
  • the solvent can be an alcohol, for example, ethanol, propyl alcohol, butyl alcohol, pentanol, benzyl alcohol, or any isomers or combinations thereof.
  • the ethanol can be dehydrated enthanol.
  • the composition can include up to 50% (w/v) alcohol, for example, 10% to 24% (w/v).
  • Diazepam nasal spray is a novel formulation that incorporates diazepam in a manner that is compact, portable and designed to be easily administered, with a pharmacokinetic profile comparable to rectally administered diazepam, but with nasal delivery.
  • Nasal delivery refers to the fact that the active ingredient is delivered through nasal routes.
  • An effective dose is defined as the amount of a drug that is sufficient to achieve the desired clinical improvement. The surprising result is that the nasal delivery results in a food effect, resulting in absorption of some drug in areas other than the nasal cavity.
  • a benzodiazepine drug can be administered with a monomodal delivery profile.
  • diazepam can also be administered with a multimodal delivery profile.
  • the benzodiazepine drug can be administered with at least a bimodal delivery profile. .
  • a benzodiazepine drug can include alprazolam, brotizolam, chlordiazepoxide, clobazam, clonazepam, clorazepam, demoxazepam, diazepam, flumazenil, flurazepam, halazepam, midazolam, nordazepam, medazepam, nitrazepam, oxazepam, lorazepam, prazepam, quazepam, triazolam, temazepam, loprazolam, or any pharmaceutically-acceptable salts thereof, and any combinations thereof.
  • the composition can include 1 to 40% (w/v) benzodiazepine drug, for example, 5% to 30% (w/v) benzodiazepine drug.
  • the composition can be dispensed as a spray having a volume of 0.025, 0.05, 0.075, 0.1, 0.125, 0.150, 0.2, or 0.25 mL per spray (or puff or spray actuation).
  • the active content per spray can be 1 mg, 1.25 mg, 1.5 mg, 1.75 mg, 2 mg, 2.25mg, 2.75 mg, 3 mg, 3.25 mg, 3.5 mg, 3.75 mg, 4 mg, 4.25 mg, 4.5 mg, 4.75 mg, 5 mg, 5.25 mg, 5.5 mg, 5.75 mg, 6 mg, 6.25 mg, 6.5 mg, 6.75 mg, 7 mg, 7.25 mg, 7.5 mg, 7.75 mg, 8 mg, 9 mg, 10 mg, 12 mg, 14 mg, 16 mg, 18 mg, 20 mg, 22 mg, 24 mg, 25 mg, 26 mg, 28 mg, 30 mg, 32 mg, 34 mg, 36 mg, 38 mg, or 40 mg.
  • administering a benzodiazepine drug includes spraying a first dose of a pharmaceutical formulation including a benzodiazepine drug in one or more nostrils of the subject.
  • the first dose can be a first effective dose.
  • a first effective does can be administered in a single nostril.
  • a pharmaceutical formulation can be separately administered in both nostrils to deliver a first effective dose.
  • a second dose can be a second effective dose.
  • administering benzodiazepine drug includes spraying a second dose of a pharmaceutical formulation including a benzodiazepine drug in one or more nostrils of the subject.
  • a second effective dose can be administered in a single nostril.
  • a pharmaceutical formulation can be separately administered in both nostrils to deliver a second effective dose.
  • the second dose can be to a subject in a fed state or an unfed state, or in a level of a fed state. If the subject is no longer in a fed state, the second dose can be efficacious at a dose level different from the first dose. Further doses can be administered and delivered in a similar manner to the first and second effective dose.
  • the effective dose of the benzodiazepine drug being at least 5% higher than a non-fed state effective dose for the patient.
  • the first dose contains the concentration of the benzodiazepine drug that is at least 5% higher than a non-fed state effective dose for the subject. In certain embodiments, administering the first dose and the second dose together contain the concentration of the benzodiazepine drug that is at least 10% higher than a non-fed state effective dose for the subject.
  • administering the first dose and the second dose together contain the concentration of the benzodiazepine drug that is higher than a non-fed state effective dose for the subject. In certain embodiments, the concentration of the benzodiazepine drug is at least 15% higher than a non-fed state effective dose for the subject.
  • a treatment cycle is a period of treatment, followed by a period of rest, which can be repeated on a regular basis.
  • a first effective dose can be administered in one nostril in the same treatment cycle.
  • a first effective dose can be administered in more than one nostril in the same treatment cycle.
  • a first effective dose can be administered in each nostril in separate treatment cycles.
  • diazepam The absorption of diazepam through the mucosa can be governed by several factors including the ability of the molecule to permeate and traverse the oral mucosa to reach the systemic or vascular system. Despite significant improvements to the permeation rate, through the incorporation of a penetration enhancer into the formulation, only a portion of the diazepam is delivered transmucosally. The remainder of the diazepam is washed away through salivary flow or swallowed and drains into the other mucosal areas such as the pharyngeal, esophogeal and gastrointestinal tract where it is absorbed into the body, for example, by a transpharyngeal, transesophogeal or transgastrointestinal mechanism.
  • Onset of absorption can be as rapid as about 15 min or less and Tmax can also be observed in the range of about 1 hr to 1.5 hours for example.
  • onset of absorption can be delayed to approximately 45 min and Tmax is delayed to about 2-3 hours.
  • Cmax is reported to decrease by approximately 28% after a moderate fat meal.
  • the recommended DBF (diazepam buccal film) or DNS (diazepam nasal spray) dose for each weight class as defined in the DRG label was selected (1) to provide a dose sufficiently high to ensure that the predicted median of the resulting diazepam Cmax following a moderate fat or high fat meal was similar to the median Cmax following the labeled dose of Diastat rectal gel, and (2) to provide a dose for which the predicted median of the resulting diazepam Cmax under fasting conditions would not exceed the median Cmax values observed and demonstrated as safe in studies with DBF or DNS.
  • the results showed excellent agreement between the 5mg DBF and 5mg DRG and also supported dose proportionality between the 20mg DBF and 5mg DBF. This is in contrast to the lack of proportionality between the 5mg DRG to the 20mg DRG as shown in Fig. 1C.
  • the 20 mg DBF was predicated to achieve about 367 ng/ml, but unexpectedly achieved over 600 ng/ml, or over 180% of the Target Cmax.
  • DBF can reach a therapeutic window within 1 hour or less. In certain conditions, DBF can reach a therapeutic window within 45 minutes, within 30 minutes, within 15 minutes, within 10 minutes, or within 5 minutes or less. In certain conditions, DBF can reach a therapeutic window in 5 minutes or more. In certain conditions, DBF can reach a therapeutic window in greater than 10 minutes, greater than 15 minutes, greater than 30 minutes, or greater than 45 minutes. In a therapeutic window for DBF, blood levels of no less than 100 ng/ml, 90 ng/ml, 80 ng/ml, 70 ng/ml, 60 ng/ml, 50 ng/ml, 40 ng/ml, 30 ng/ml.
  • a therapeutic window for DBF results in blood levels of no more than 10 ng/ml, 20 ng/ml, 30 ng/ml, 40 ng/ml, 50 ng/ml, 60 ng/ml, 70 ng/ml, 80 ng/ml. 90 ng/ml, or 100 ng/ml DBF can be observed.
  • 17.5 mg DBF unexpectedly delivers same bioavailability as DRG. Moreover, 17.5 mg DBF was also found unexpectedly deliver the same Cmax under moderate fat conditions, as 20 mg DRG.
  • DBF differed from DRG in the following respects (1) DBF exhibited higher bioavailability than DRG; (2) The PK behavior of DBF was linear. Specifically, for DBF both Cmax and AUC increased in proportion to the dose. In contrast, the PK behavior of DRG was not linear. Specifically, for DRG, Cmax increased with dose to a degree that was less than doseproportional, whereas AUC increased in proportion to the dose. (3) DBF exhibited a food effect (-45% reduction on average in Cmax after a high fat meal and -33% reduction on average after a moderate fat meal with no change in AUC). In contrast, it is assumed that DRG, because of its rectal route of administration, is not affected by food. There can be less intersubject variability with a transmucosal or transbuccal film as compared to a rectally delivered Diastat gel.
  • the recommended DBF dose corresponding to each weight class as defined in the Diastat rectal gel label was selected (1) to provide a dose sufficiently high to ensure that the predicted median of the resulting diazepam Cmax following a moderate fat meal was similar to the median Cmax following the labeled dose of Diastat rectal gel, and (2) to provide a dose for which the predicted median of the resulting diazepam Cmax under fasting conditions would not exceed the median Cmax values observed and demonstrated as safe in Phase 1 healthy volunteer studies with DBF.
  • the proposed DBF dosing regimen produced for each weight class a Cmax similar to the Cmax expected following the labeled dose of Diastat rectal gel.
  • the dosing regime can be as indicated in the following charts: Population pharmacokinetic modeling was used to model the pharmacokinetic profiles for DBF and Diastat rectal gel under fasted and fed conditions. The modeling can show acceptable profiles under fasting conditions, after a moderate fat meal, or after a high fat meal. The profiles can differ for male subjects and female subjects. Female subjects can have lower plasma concentrations.
  • the method of treating a medical condition includes delivering 0.1-0.4 mg/kg of diazepam, for example, 0.1-0.3 mg/kg of diazepam.
  • the dose can be lower than the comparable Diastat dose for a weight class of subject, for example, in the fasted state. In other embodiments, the dose can be higher than the comparable Diastat dose for a weight class of subject, for example, in the fed state.
  • DPF diazepam buccal film
  • DBF doses of 5 mg to 15 mg exhibited rapid absorption and linear dose-proportional pharmacokinetics.
  • diazepam rectal gel showed sublinear dose-proportional pharmacokinetics for Cmax.
  • Recent studies in animal models indicate that plasma diazepam concentrations in the range of 70 ng/ml are associated with an elevation in seizure threshold. See, e.g. Dhir A, Rogawski MA. Determination of minimal steady-state plasma level of diazepam causing seizure threshold elevation in rats. Epilepsia. 2018 May; 59(5):935-944. doi: 10.1111/epi.14069. Epub 2018 Apr 6.
  • PubMed PMID 29682729
  • PubMed Central PMCID PMC5934328
  • the straight-line interpolated Cmax value for a 12.5 mg DBF dose in fasted healthy volunteers based on the data presented in Fig. 1A is 417 ng/mL, which is substantially greater than the geometric mean Cmax values obtained in the study with subjects with epilepsy.
  • Diazepam is N-demethylated by CYP3A4 and CYP2C19 so that its clearance is increased by inducers of these isozymes. See, e.g., Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand. 2008 Aug;118(2):69-86. doi: 10.1111/j.1600-0404.2008.01004.x.
  • Solubility and permeability of the pharmaceutically active component in vivo, in particular, in the mouth of a subject, can vary tremendously.
  • a particular class of permeation enhancer can improve the uptake and bioavailability of the pharmaceutically active component in vivo.
  • the permeation enhancer when delivered to the mouth via a film, can improve the permeability of the pharmaceutically active component through the mucosa and into the blood stream of the subject.
  • the permeation enhancer can improve absorption rate and amount of the pharmaceutically active component by more than 5%, more than 10%, more than 20%, more than 30%, more than 40%, more than 50%, more than 60%, more than 70%, more than 80%, more than 90%, more than 100%, more than 150%, about 200% or more, or less than 200%, less than 150%, less than 100%, less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, or less than 5%, or a combination of these ranges, depending on the other components in the composition.
  • suitable permeation enhancers are shown, for example, U.S. Patent Application 15/587,364 and U.S. Patent Application 15/791,249, each of which is incorporated by reference in its entirety.
  • a pharmaceutical composition has a suitable nontoxic, nonionic alkyl glycoside having a hydrophobic alkyl group joined by a linkage to a hydrophilic saccharide in combination with a mucosal delivery-enhancing agent selected from: (a) an aggregation inhibitory agent; (b) a charge-modifying agent; (c) a pH control agent; (d) a degradative enzyme inhibitory agent; (e) a mucolytic or mucus clearing agent; (f) a ciliostatic agent; (g) a membrane penetration-enhancing agent selected from: (i) a surfactant; (ii) a bile salt; (ii) a phospholipid additive, mixed micelle, liposome, or carrier; (iii) an alcohol; (iv) an enamine; (v) an NO donor compound; (vi) a long chain amphipathic molecule; (vii) a small hydrophobic penetration enhancer; (viii) sodium or a salicylic acid derivative
  • An alkyl glycoside can be a dodecyl maltoside.
  • the composition can include up to 1%, 0.5%, or 0.25% (w/v) of the alkyl glycoside.
  • Nasal drug administration has been used as an alternative route for the systemic availability of drugs due to the large surface area area, porous endothelial membrane, high total blood flow, the avoidance of first-pass metabolism, and ready accessibility.
  • the drugs are cleared rapidly from the nasal cavity after intranasal administration, resulting in rapid, systemic drug absorption.
  • delivering the a benzodiazepine as a spray results in the effective dose of the benzodiazepine drug being at least 5% higher than a non-fed state effective dose for the patient.
  • the effective dose of the benzodiazepine drug is at least 8%, 10%, 20%, or 25% higher than a non-fed state effective dose for the patient.
  • the concentration of the benzodiazepine drug can be at least 50% higher than a non-fed state effective dose for the patient.
  • the concentration of the benzodiazepine drug can be at least 60% higher than a non-fed state effective dose for the patient.
  • the first dose contains the concentration of the benzodiazepine drug that is at least 40% higher than a non-fed state effective dose for the subject.
  • the treatment achieves bioavailability that is from about 40 to 125% of that achieved with the same benzodiazepine administered intravenously.
  • the oral mucosa might be an attractive site for the delivery of therapeutic agents into the systemic circulation. Due to the direct drainage of blood from the buccal epithelium into the internal jugular vein first-pass metabolism in the liver and intestine may be avoided. First-pass effect can be a major reason for the poor bioavailability of some compounds when administered orally. Additionally, the mucosa lining in the oral cavity is easily accessible, which ensures that a dosage form can be applied to the required site and can be removed easily in the case of an emergency. However, like the skin, the buccal mucosa acts as a barrier to the absorption of xenobiotics, which can hinder the permeation of compounds across this tissue. The presence of no or little oral irritation is also a factor that is important when utilizing a transmucosal delivery system. Consequently, the identification of safe and effective penetration enhancers has become a major goal in the quest to improve oral mucosal drug delivery.
  • Chemical penetration enhancers are substances that control the permeation rate of a coadministered or sequentially administered drug through a biological membrane. While extensive research has focused on obtaining an improved understanding of how penetration enhancers might alter intestinal and transdermal permeability, far less is known about the mechanisms involved in mucosal penetration enhancement.
  • the buccal mucosa delineates the inside lining of the cheek as well as the area between the gums and upper and lower lips and it has an average surface area of 100 cm 2 .
  • the surface of the buccal mucosa consists of a stratified squamous epithelium which is separated from the underlying connective tissue (lamina intestinal and submucosa) by an undulating basement membrane (a continuous layer of extracellular material approximately 1-2 pm in thickness).
  • This stratified squamous epithelium consists of differentiating layers of cells which change in size, shape, and content as they travel from the basal region to the superficial region, where the cells are shed. There are approximately 40-50 cell layers, resulting in a buccal mucosa which is 500- 600 pm thick.
  • the sublingual mucosa is comparable to the buccal mucosa but the thickness of this epithelium is 100-200 pm. This membrane is also non-keratinised and being relatively thinner has been demonstrated to be more permeable than buccal mucosa. Blood flow to the sublingual mucosal is slower compared with the buccal mucosa and is of the order of 1.0 ml/ min’ cm’ 2 . However, the salivary flow to the sublingual region is greater than the buccal mucosa thereby offering challenges that can prematurely cause dilution and subsequent swallowing of the drug before it can penetrate the sublingual mucosa.
  • the permeability of the buccal mucosa is greater than that of the skin, but less than that of the intestine.
  • the differences in permeability are the result of structural differences between each of the tissues.
  • the absence of organized lipid lamellae in the intercellular spaces of the buccal mucosa results in greater permeability of exogenous compounds, compared to keratinized epithelia of the skin; while the increased thickness and lack of tight junctions results in the buccal mucosa being less permeable than intestinal tissue.
  • the primary barrier properties of the buccal mucosa have been attributed to the upper one-third to one-quarter of the buccal epithelium.
  • researchers have learned that beyond the surface epithelium, the permeability barrier of nonkeratinized oral mucosa could also be attributed to contents extruded from the membrane-coating granules into the epithelial intercellular spaces.
  • the intercellular lipids of the nonkeratinized regions of the oral cavity are of a more polar nature than the lipids of the epidermis, palate, and gingiva, and this difference in the chemical nature of the lipids may contribute to the differences in permeability observed between these tissues. Consequently, it appears that it is not only the greater degree of intercellular lipid packing in the stratum corneum of keratinized epithelia that creates a more effective barrier, but also the chemical nature of the lipids present within that barrier.
  • hydrophilic and lipophilic regions in the oral mucosa have led researchers to postulate the existence of two routes of drug transport through the buccal mucosa which are paracellular (between the cells) and transcellular (across the cells).
  • a chemical penetration enhancer, or absorption promoter is a substance added to a pharmaceutical formulation in order to increase the membrane permeation or absorption rate of the coadministered drug, without damaging the membrane and/or causing toxicity.
  • chemical penetration enhancers have been many studies investigating the effect of chemical penetration enhancers on the delivery of compounds across the skin, nasal mucosa, and intestine. In recent years, more attention has been given to the effect of these agents on the permeability of the buccal mucosa. Since permeability across the buccal mucosa is considered to be a passive diffusion process the steady state flux (Jss) should increase with increasing donor chamber concentration (CD) according to Fick’s first law of diffusion.
  • the permeation enhancers can be applied in an oral mucosa, e.g. in buccal or sublingual administration.
  • a permeation enhancer can be a synthetic compound.
  • a permeation enhancer can be a biosynthetic compound.
  • a permeation enhancer can be a natural compound. In other embodiments, a permeation enhancer can include a combination of compounds from one or more of these categories of compounds.
  • a composition can include up to 40% (w/v), for example, 1% to 30% (w/v) benzyl alcohol. Fatty acids have been shown to enhance the permeation of a number of drugs through the skin, and this has been shown by differential scanning calorimetry and Fourier transform infrared spectroscopy to be related to an increase in the fluidity of intercellular lipids.
  • pretreatment with ethanol has been shown to enhance the permeability of tritiated water and albumin across ventral tongue mucosa, and to enhance caffeine permeability across porcine buccal mucosa.
  • Azone® a biocompatible and biodegradable polymer
  • Oral transmucosal drug delivery is the administration of pharmaceutically active agents through the oral mucosa to achieve systemic effects. Permeation pathways and predictive models for OTDD are described, e.g. in M. Sattar, Oral transmucosal drug delivery - Current status and future prospects, Int’l. Journal of Pharmaceutics, 47(2014) 498-506, which is incorporated by reference herein. OTDD continues to attract the attention of academic and industrial scientists.
  • buccal penetration can be improved by using various classes of transmucosal and transdermal penetration enhancers such as bile salts, surfactants, fatty acids and their derivatives, chelators, cyclodextrins and chitosan.
  • transmucosal and transdermal penetration enhancers such as bile salts, surfactants, fatty acids and their derivatives, chelators, cyclodextrins and chitosan.
  • bile salts are the most common.
  • Fluorescein isothiocyanate (FITC), morphine sulfate were each used as the model compound. Chitosan has also been shown to promote absorption of small polar molecules and peptide / protein drugs through nasal mucosa in animal models and human volunteers. Other studies have shown an enhancing effect on penetration of compounds across the intestinal mucosa and cultured Caco-2 cells.
  • the permeation enhancer can be a phytoextract.
  • a phytoextract can be an essential oil or composition including essential oils extracted by distillation of the plant material.
  • the phytoextract can include synthetic analogues of the compounds extracted from the plant material (i.e., compounds made by organic synthesis).
  • the phytoextract can include a phenylpropanoid, for example, phenyl alanine, eugenol, eugenol acetate, a cinnamic acid, a cinnamic acid ester, a cinnamic aldehyde, a hydrocinnamic acid, chavicol, or safrole, or a combination thereof.
  • the phytoextract can be an essential oil extract of a clove plant, for example, from the leaf, stem or flower bud of a clove plant.
  • the clove plant can be Syzygium aromaticum.
  • the phytoextract can include 20-95% eugenol, including 40-95% eugenol, including 60-95% eugenol, and for example, 80-95% eugenol.
  • the extract can also include 5% to 15% eugenol acetate.
  • the extract can also include caryophyllene.
  • the extract can also include up to 2.1% a-humulen.
  • Other volatile compounds included in lower concentrations in clove essential oil can be P-pinene, limonene, farnesol, benzaldehyde, 2-heptanone and ethyl hexanoate.
  • Other permeation enhancers may be added to the composition to improve absorption of the drug.
  • Suitable permeation enhancers include natural or synthetic bile salts such as sodium fusidate; glycocholate or deoxycholate and their salts; fatty acids and derivatives such as sodium laurate, oleic acid, oleyl alcohol, monoolein, and palmitoylcamitine; chelators such as disodium EDTA, sodium citrate and sodium lauryl sulfate, azone, sodium cholate, sodium 5- methoxysalicylate, sorbitan laurate, glyceryl monolaurate, octoxynonyl-9, laureth-9, polysorbates, sterols, or glycerides, such as caprylocaproyl polyoxylglycerides, e.g., Labrasol.
  • the permeation enhancer can include phytoextract derivatives and/or monolignols.
  • the permeation enhancer can also be a fungal extract.
  • vasodilatory effect Some natural products of plant origin have been known to have a vasodilatory effect. There are several mechanisms or modes by which plant-based products can evoke vasodilation. For review, see McNeill J.R. and Jurgens, T.M., Can. J. Physiol. Pharmacol. 84:803-821 (2006), which is incorporated by reference herein. Specifically, vasorelaxant effects of eugenol have been reported in a number of animal studies. See, e.g., Lahlou, S., et al., J. Cardiovasc. Pharmacol. 43:250-57 (2004), Damiani, C.E.N., et al., Vascular Pharmacol.
  • Fatty acids can be used as inactive ingredients in drug preparations or drug vehicles. Fatty acids can also be used as formulation ingredients due to their certain functional effects and their biocompatible nature. Fatty acid, both free and as part of complex lipids, are major metabolic fuel (storage and transport energy), essential components of all membranes and gene regulators. For review, see Rustan A.C. and Drevon, C.A., Fatty Acids: Structures and Properties, Encyclopedia of Life Sciences (2005), which is incorporated by reference herein. There are two families of essential fatty acids that are metabolized in the human body: co-3 and co-6 polyunsaturated fatty acids (PUFAs). If the first double bond is found between the third and the fourth carbon atom from the co carbon, they are called co-3 fatty acids.
  • PUFAs polyunsaturated fatty acids
  • first double bond is between the sixth and seventh carbon atom, they are called co-6 fatty acids.
  • PUFAs are further metabolized in the body by the addition of carbon atoms and by desaturation (extraction of hydrogen).
  • Linoleic acid which is a co-6 fatty acid, is metabolized to y-linolenic acid, dihomo-y- linolinic acid, arachidonic acid, adrenic acid, tetracosatetraenoic acid, tetracos apentaenoic acid, docosapentaenoic acid, a-linolenic acid, which is a co-3 fatty acid is metabolized to octadecatetraenoic acid, eicosatetraenoic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid, tetracosapentaenoic acid, tetracosahexa
  • fatty acids such as palmitic acid, oleic acid, linoleic acid and eicosapentaenoic acid
  • fatty acids such as palmitic acid, oleic acid, linoleic acid and eicosapentaenoic acid
  • fatty acids such as palmitic acid, oleic acid, linoleic acid and eicosapentaenoic acid
  • the pulmonary vascular response to arachidonic acid can be either vasoconstrictive or vasodilative, depending on the dose, animal species, the mode of arachidonic acid administration, and the tones of the pulmonary circulation.
  • arachidonic acid has been reported to cause cyclooxygenase-dependent and -independent pulmonary vasodilation. See, Feddersen, C.O. et al., J. Appl. Physiol. 68(5): 1799-808 (1990); and see, Spannhake, E.W., et al., J. Appl. Physiol. 44:397-495 (1978) and Wicks, T.C. et al., Circ. Res. 38:167-71 (1976), each of which is incorporated by reference herein.
  • the arrangement, order, or sequence of penetration enhancer(s) and active pharmaceutical ingredient(s) (API(s)) delivered to the desired mucosal surface can vary in order to deliver a desired pharmacokinetic profile. For example, one can apply the permeation enhancer(s) first by a film, by swab, spray, gel, rinse or by a first layer of a film then apply the API(s) by single film, by swab, or by a second layer of a film.
  • the sequence can be reversed or modified, for example, by applying the API(s) first by film, by swab, or by a first layer of a film, and then applying the permeation enhancer(s) by a film, by swab, spray, gel, rinse or by a second layer of a film.
  • the penetration enhancer(s) can be used as a pretreatment alone or in combination with at least one API to precondition the mucosa for further absorption of the API(s).
  • the treatment can be followed by another treatment with neat penetration enhancer(s) to follow the at least one API mucosal application.
  • the pretreatment can be applied as a separate treatment (film, gel, solution, swab etc.) or as a layer within a multilayered film construction of one or more layers.
  • the pretreatment may be contained within a distinct domain of a single film, designed to dissolve and release to the mucosa prior to release of the secondary domains with or without penetration enhancer(s) or API(s).
  • the active ingredient may then be delivered from a second treatment, alone or in combination with additional penetration enhancer(s).
  • additional penetration enhancer(s) There may also be a tertiary treatment or domain that delivers additional penetration enhancer(s) and/or at least one API(s) or prodrug(s), either at a different ratio relative to each other or relative to the overall loading of the other treatments.
  • This allows a custom pharmacokinetic profile to be obtained.
  • the product may have single or multiple domains, with penetration enhancer(s) and API(s) that can vary in mucosal application order, composition, concentration, or overall loading that leads to the desired absorption amounts and/or rates that achieve the intended pharmacokinetic profile and/or pharmacodynamic effect.
  • the film format can be oriented such that no distinct sides, or such that the film has at least one side of a multiple layer film where the edges are co-terminus (having or meeting at a shared border or limit).
  • the pharmaceutical composition can be a chewable or gelatin or lyophilized or inhalation based dosage form, spray, gum, gel, cream, tablet, capsule, liquid or film.
  • the composition can include textures, for example, at the surface, such as microneedles or micro-protrusions.
  • microneedles or micro-protrusions have been shown to significantly increase transdermal delivery, including and especially for macromolecules.
  • solid microneedles which have been shown to increase skin permeability to a broad range of molecules and nanoparticles in vitro.
  • In vivo studies have demonstrated delivery of oligonucleotides, reduction of blood glucose level by insulin, and induction of immune responses from protein and DNA vaccines.
  • microneedles have been used to pierce holes into skin to increase transport by diffusion or iontophoresis or as drug carriers that release drug into the skin from a microneedle surface coating. Hollow microneedles have also been developed and shown to microinject insulin to diabetic rats. To address practical applications of microneedles, the ratio of microneedle fracture force to skin insertion force (i.e. margin of safety) was found to be optimal for needles with small tip radius and large wall thickness. Microneedles inserted into the skin of human subjects were reported as painless. Together, these results suggest that microneedles represent a promising technology to deliver therapeutic compounds into the skin for a range of possible applications.
  • Microneedles have been fabricated with a range of sizes, shapes and materials.
  • Microneedles can be, for example, polymeric, microscopic needles that deliver encapsulated drugs in a minimally invasive manner, but other suitable materials can be used.
  • Microneedles can be used to enhance the delivery of drugs through the oral mucosa, particularly with the claimed compositions.
  • the microneedles create micron sized pores in the oral mucosa which can enhance the delivery of drugs across the mucosa.
  • Solid, hollow or dissolving microneedles can be fabricated out of suitable materials including, but not limited to, metal, polymer, glass and ceramics.
  • the microfabrication process can include photolithography, silicon etching, laser cutting, metal electroplating, metal electro polishing and molding.
  • Microneedles could be solid which is used to pretreat the tissue and are removed before applying the film.
  • the drug loaded polymer film described in this application can be used as the matrix material of the microneedles itself. These films can have microneedles or micro protrusions fabricated on their surface which will dissolve after forming microchannels in the mucosa through which drugs can permeate.
  • film can include films and sheets, in any shape, including rectangular, square, or other desired shape.
  • a film can be any desired thickness and size.
  • a film can have a thickness and size such that it can be administered to a user, for example, placed into the oral cavity of the user.
  • a film can have a relatively thin thickness of from about 0.0025mm to about 0.250mm, or a film can have a somewhat thicker thickness of from about 0.250mm to aboutl.Omm. For some films, the thickness may be even larger, i.e., greater than about 1.0mm or thinner, i.e., less than about 0.0025mm.
  • a film can be a single layer or a film can be multi-layered, including laminated or multiple cast films.
  • a permeation enhancer and pharmaceutically active component can be combined in a single layer, each contained in separate layers, or can each be otherwise contained in discrete regions of the same dosage form.
  • the pharmaceutically active component contained in the polymeric matrix can be dispersed in the matrix.
  • the permeation enhancer being contained in the polymeric matrix can be dispersed in the matrix.
  • Oral dissolving films can fall into three main classes: fast dissolving, moderate dissolving and slow dissolving. Oral dissolving films can also include a combination of any of the above categories.
  • Fast dissolving films can dissolve in about 1 second to about 30 seconds in the mouth, including more than 1 second, more than 5 seconds, more than 10 seconds, more than 20 seconds, or less than 30 seconds.
  • Moderate dissolving films can dissolve in about 1 to about 30 minutes in the mouth including more than 1 minute, more than 5 minutes, more than 10 minutes, more than 20 minutes or less than 30 minutes, and slow dissolving films can dissolve in more than 30 minutes in the mouth.
  • fast dissolving films can include (or consist of) low molecular weight hydrophilic polymers (e.g., polymers having a molecular weight between about 1,000 to 9,000 daltons, or polymers having a molecular weight up to 200,000 daltons).
  • slow dissolving films generally include high molecular weight polymers (e.g., having a molecular weight in millions). Moderate dissolving films can tend to fall in between the fast and slow dissolving films.
  • Moderate dissolving films can dissolve rather quickly, but also have a good level of mucoadhesion.
  • Moderate dissolving films can also be flexible, quickly wettable, and are typically non-irritating to the user.
  • Such moderate dissolving films can provide a quick enough dissolution rate, most desirably between about 1 minute and about 20 minutes, while providing an acceptable mucoadhesion level such that the film is not easily removable once it is placed in the oral cavity of the user. This can ensure delivery of a pharmaceutically active component to a user.
  • a pharmaceutical composition can include one or more pharmaceutically active components.
  • the pharmaceutically active component can be a single pharmaceutical component or a combination of pharmaceutical components.
  • the pharmaceutically active component can be an anti-inflammatory analgesic agent, a steroidal anti-inflammatory agent, an antihistamine, a local anesthetic, a bactericide, a disinfectant, a vasoconstrictor, a hemostatic, a chemotherapeutic drug, an antibiotic, a keratolytic, a cauterizing agent, an antiviral drug, an antirheumatic, an antihypertensive, a bronchodilator, an anticholinergic, an anti-anxiety drug, an antiemetic compound, a hormone, a peptide, a protein or a vaccine.
  • the pharmaceutically active component can be a pharmaceutically acceptable salt of a drug, a prodrug, a derivative, a drug complex or analog of a drug.
  • prodrug refers to a biologically inactive compound that can be metabolized in the body to produce a biologically active drug or the “prodrug” can be a biologically active compound where in addition to its inherent biological activity can be metabolized to another or even preferred biologically active drug.
  • the prodrug can have its own biological activity that can be similar to or different from the active drug.
  • the prodrug can be an ester of epinephrine, for example, dipivefrin which is hydrolysed into epinephrine. See, e.g., J.
  • the prodrug can be a prodrug of benzodiazepines such as avizafone, which is a prodrug of diazepam.
  • a prodrug from the benzodiazepine chemical series is ethyl loflazepate.
  • Chemical derivatives, analogs or prodrugs of all benzodiazepines are all considered within the scope of this invention.
  • more than one pharmaceutically active component may be included in the film.
  • the pharmaceutically active components can be ace-inhibitors, anti-anginal drugs, anti-arrhythmias, anti-asthmatics, anti-cholesterolemics, analgesics, anesthetics, anticonvulsants, anti-depressants, anti-diabetic agents, anti-diarrhea preparations, antidotes, antihistamines, anti-hypertensive drugs, anti-inflammatory agents, anti-lipid agents, anti-manics, anti-nauseants, anti-stroke agents, anti-thyroid preparations, amphetamines, anti-tumor drugs, anti-viral agents, acne drugs, alkaloids, amino acid preparations, anti-tussives, anti-uricemic drugs, anti-viral drugs, anabolic preparations, systemic and non-systemic anti-infective agents, anti-neoplastics, anti-parkinsonian agents, anti-rheu
  • Suitable actives for use in the films herein include, but are not limited to, the following therapeutic classes: ace-inhibitor; adrenergic agent; adrenocortical steroid; adrenocortical suppressant; aldosterone antagonist; alkaloid; amino acid; anabolic; analeptic; analgesic; anesthetic; anorectic; anti-acne agent; anti- adrenergic; antiallergic; anti-amebic; anti-anemic; anti-anginal; anti-anxiety; anti- arthritic; anti-arrythmia; antiasthmatic; anti-atherosclerotic; anti-cholesterolemic; antibacterial; antibiotic; anticholinergic; anticoagulant; anticonvulsant; antidepressant; antidiabetic; antidiarrheal; antidiuretic; antidote; anti-emetic; anti-epileptic; antifibrinolytic
  • actives suitable for use herein include antacids, th-antagonists, and analgesics.
  • antacid dosages can be prepared using the ingredients calcium carbonate alone or in combination with magnesium hydroxide, and/or aluminum hydroxide.
  • antacids can be used in combination with FE-antagonists.
  • Analgesics include opiates and opiate derivatives, such as oxycodone (commercially available as Oxycontin®); ibuprofen (commercially available as Motrin®, Advil®, Motrin Children's®, Motrin IB®, Advil Children's®, Motrin Infants'®, Motrin Junior®, Ibu-2®, Proprinal®, Ibu-200®, Midol Cramp Formula®, Bufen®, Motrin Migraine Pain®, Addaprin® and Haltran®), aspirin (commercially available as Empirin®, Ecotrin®, Genuine Bayer®, and Halfprin®), acetaminophen (commercially available as Silapap Infant's®, Silapap Children's®, Tylenol®, Tylenol Children's®, Tylenol Extra Strength®, Tylenol Infants' Original®, Tylenol Infants'®, Tylenol Arthritis®, T-
  • pain relieving agents may be used in the present invention, including meperidine hydrochloride (commercially available as Demerol®), capsaicin (commercially available as Qutenza®), morphine sulfate and naltrexone hydrochloride (commercially available as Embeda®), hydromorphone hydrochloride (commercially available as Dilaudid®), propoxyphene napsylate and acetaminophen (commercially available as Darvocet-N®), Fentanyl (commercially available as Duragesic®, Onsolis®, and Fentora®), sodium hyaluronate (commercially available as Euflexxa®), adalimumab (commercially available as Humira®), sumatriptan succinate (commercially available as Imitrex®), fentanyl iontophoretic (commercially available as lonsys®), orphenadrine citrate (commercially available as Norgesic®), magnesium salicylate tetrahydrate (commercially available as
  • the films disclosed herein may further include agents such as NSAIDs, including etodolac (commercially available as Lodine®), ketorolac tromethamine (commercially available as Acular® or Acuvail®), naproxen sodium (commercially available as Anaprox®, Naprosyn®), flurbiprofen (commercially available as Ansaid®), diclofenac sodium/misoprostol (commercially available as Arthrotec®), celecoxib (commercially available as Celebrex®), sulindac (commercially available as Clinoril®), oxaprozin (commercially available as Daypro®), piroxicam (commercially available as Feldene®), indomethacin (commercially available as Indocin®), meloxicam (commercially available as Mobic®), mefenamic acid (commercially available as Ponstel®), tolmetin sodium (commercially available as Tolectin®), choline magnesium trisalicylate (commercially available as Trilisate®),
  • Opiate agonists and antagonists such as buprenorphine and naloxone are further examples of drugs for use in the present invention.
  • Other drugs for other actives for use herein include anti-diarrheals such as loperamide (commercially available as Imodium AD®, Imotil®, Kaodene®, Imperim®, Diamode®, QC Anti-Diarrheal®, Health Care America Anti-Diarrheal®, Leader A-D®, and Imogen®), nitazoxanide (commercially available as Alinia®) and diphenoxylate hydrochloride/atropine sulfate (commercially available as Lomotil®), anti-histamines, anti-tussives, decongestants, vitamins, and breath fresheners.
  • anti-diarrheals such as loperamide (commercially available as Imodium AD®, Imotil®, Kaodene®, Imperim®, Diamode®, QC Anti-Diarr
  • Common drugs used alone or in combination for colds, pain, fever, cough, congestion, runny nose and allergies such as acetaminophen, ibuprofen, chlorpheniramine maleate, dextromethorphan, dextromethorphan HBr, phenylephrine HC1, pseudoephedrine HC1, diphenhydramine and combinations thereof, such as dextromethophan HBr and phenylephrine HC1 (available as Triaminic®) may be included in the film compositions of the present invention.
  • actives useful herein include, but are not limited to, alcohol dependence treatment, such as acamprosate calcium (commercially available as Campral®); Allergy treatment medications, such as promethazine hydrochloride (commercially available as Phenergan®), bepotastine besilate (commercially available as Bepreve®), hydrocodone polistirex/chlorpheniramine polistirex (commercially available as Tussionex®), cetirizine hydrochloride (commercially available as Zyrtec®), cetirizine hydrochloride/pseudoephedrine hydrochloride (commercially available as Zyrtec-D®), promethazine hydrochloride/codeine phosphate (commercially available as Phenergan® with Codeine), pemirolast (commercially available as Alamast®), fexofenadine hydrochloride (commercially available as Allegra®), meclizine hydrochloride (commercially available as Antivert®), azelastine hydro
  • Films of the present disclosure may further include Alzheimer’s treatment medications, such as tacrine hydrochloride (commercially available as Cognex®), galantamine (commercially available as Razadyne®), donepezil hydrochloride (commercially available as Aricept®), rivastigmine tartrate (commercially available as Exelon®), caprylidene (commercially available as Axona®), and memantine (commercially available as Namenda®); anemia medication, such as cyanocobalamin (commercially available as Nascobal®) and ferumoxytol (commercially available as Feraheme®); anesthetics, such as antipyrine with benzocaine (commercially available as Auralgan®, Aurodex® and Auroto®); angina medication, such as amlodipine besylate (commercially available as Norvasc®), nitroglycerin (commercially available as NitroBid®, Nitro-Dur®, Nitrolingual®, Nitrostat®, Transderm-Nitr
  • Actives useful in the present disclosure may also include anti-asthmatics, such as albuterol sulfate (commercially available as Proventil®), ipratropium bromide (commercially available as Atrovent®), salmeterol xinafoate (commercially available as Serevent®), zafirlukast (commercially available as Accolate®), flunisolide (commercially available as AeroBid®), metaproterenol sulfate (commercially available as Alupent®), albuterol inhalation (commercially available as Ventolin®), terbutaline sulfate (commercially available as Brethine®), formoterol (commercially available as Foradil®), cromolyn sodium (commercially available as Intal®), levalbuterol hydrochloride (commercially available as Xopenex®), zileuton (commercially available as Zyflo®), fluticasone propionate/salmeterol (commercially available as Advair
  • the films of the present disclosure may further include one or more antibiotics, including amoxicillin (commercially available as Amoxil®), ampicillin (commercially available as Omnipen®, Polycillin® and Principen®), amoxicillin/clavulanate potassium (commercially available as Augmentin®), moxifloxacin hydrochloride (commercially available as Avelox®), besifloxacin (commercially available as Besivance®), clarithromycin (commercially available as Biaxin®), ceftibuten (commercially available as Cedax®), cefuroxime axetil (commercially available as Ceftin®), cefprozil (commercially available as Cefzil®), ciprofloxacin hydrochloride (commercially available as Ciloxan® and Cipro®), clindamycin phosphate (commercially available as Cleocin T®), doxycycline hyclate (commercially available as Doryx®), dirithromycin (commercially available as Dynabac®),
  • erythromycin topical (commercially available as A/T/S®, Erycette®, T-Stat®), gemifloxacin (commercially available as Factive®), ofloxacin (commercially known as Ocuflox®, Floxin®), telithromycin (commercially available as Ketek®), lomefloxacin hydrochloride (commercially available as Maxaquin®), minocycline hydrochloride (commercially available as Minocin®), fosfomycin tromethamine (commercially available as Monurol®), penicillin with potassium (commercially available as Penicillin VK®, Veetids®), trimethoprim (commercially available as Primsol®), ciprofloxacin hydrochloride (commercially available as Proquin XR®), rifampin, isoniazid and pyrazinamide (commercially available as
  • cancer treatment medications including cyclophosphamide (commercially available as Cytoxan®), methotrexate (commercially available as Rheumatrex® and Trexal®), tamoxifen citrate (commercially available as Nolvadex®), bevacizumab (commercially available as Avastin®), everolimus (commercially available as Afinitor®), pazopanib (commercially available as Votrient®), and anastrozole (commercially available as Arimidex®); leukemia treatment, such as ofatumumab (commercially available as Arzerra®); anti-thrombotic drugs, such as antithrombin recombinant lyophilized powder (commercially available as Atryn®), prasugrel (commercially available as Efient®); anti-coagulants, such as aspirin with extended-release dipyridamole (commercially available as Aggrenox®), warfarin sodium (commercially available as Coumadin®), dipyridamole
  • cancer treatment medications
  • Actives may further include anti-inflammatory medications, such as hydroxychloroquine sulfate (commercially available as Plaquenil®), fluticasone propionate (commercially available as Cutivate®), canakinumab (commercially available as Llaris®), amcinonide (commercially available as Cyclocort®), methylprednisolone (commercially available as Medrol®), budesonide (commercially available as Entocort EC®), anakinra (commercially available as Kineret®), diflorasone diacetate (commercially available as Psorcon®), and etanercept (commercially available as Enbrel®); antispasmodic medication, such as phenobarbital/hyoscyamine sulfate/atropine sulfate/scopolamine hydrobromide (commercially available as Donnatal®); antiviral treatment, such as oseltamivir phosphate (commercially available as Tamiflu®);
  • the actives included herein may also include chronic kidney disease medication, such as paricalcitol (commercially available as Zemplar®); contraceptive agents, including etonogestrel (commercially available as Implanon®), norethindrone acetate, ethinyl estradiol (commercially available as Loestrin 24 FE®), ethinyl estradiol, norelgestromin (commercially available as Ortho Evra®), levonorgestrel (commercially available as Plan B®), levonorgestrel and ethinyl estradiol (commercially available as Preven®), levonorgestrel, ethinyl estradiol (commercially available as Seasonique®), and medroxyprogesterone acetate (commercially available as Depo- Provera®); COPD medication, such as arformoterol tartrate (commercially available as Brovana®) and ipratropium bromide, albuterol sulfate (
  • Other useful actives may include digestive agents, such as sulfasalazine (commercially available as Azulfidine®), rabeprazole sodium (commercially available as AcipHex®), lubiprostone (commercially available as Amitiza®), dicyclomine hydrochloride (commercially available as Bentyl®), sucralfate (commercially available as Carafate®), lactulose (commercially available as Chronulac®), docusate (commercially available as Colace®), balsalazide disodium (commercially available as Colazal®), losartan potassium (commercially available as Cozaar®), olsalazine sodium (commercially available as Dipentum®), chlordiazepoxide hydrochloride, clidinium bromide (commercially available as Librax®), esomeprazole magnesium (commercially available as Nexium®), famotidine (commercially available as Pepcid®), lansoprazole (commercially available as Prevacid
  • Actives useful herein may also include treatment for emphysema, such as tiotropium bromide (commercially available as Spiriva®); fibromyalgia medication, such as milnacipran hydrochloride (commercially available as Savella®); medication for the treatment of gout, such as colchicine (commercially available as Colcrys®), and febuxostat (commercially available as Uloric®); enema treatments, including aminosalicylic acid (commercially available as Mesalamine® and Rowasa®); epilepsy medications, including valproic acid (commercially available as Depakene®), felbamate (commercially available as Felbatol®), lamotrigine (commercially available as Lamictal®), primidone (commercially available as Mysoline®), oxcarbazepine (commercially available as Trileptal®), zonisamide(commercially available as Zonegran®), levetiracetam (commercially available as Keppra®
  • Actives useful herein may further include eye medications and treatment, such as dipivefrin hydrochloride (commercially available as Propine®), valganciclovir (commercially available as Valcyte®), ganciclovir ophthalmic gel (commercially available as Zirgan®); bepotastine besilate (commercially available as Bepreve®), besifloxacin (commercially available as Besivance®), bromfenac (commercially available as Xibrom®), fluorometholone (commercially available as FML®), pilocarpine hydrochloride (commercially available as Pilocar®), cyclosporine (commercially available as Restasis®), brimonidine tartrate (commercially available as Alphagan P®), dorzolamide hydrochloride/timolol maleate (commercially available as Cosopt®), bimatoprost (commercially available as Lumigan®), timolol maleate (available as Timoptic®), travoprost (
  • hepatitis treatments include entecavir (commercially available as Baraclude®), hepatitis B immune globulin (commercially available as HepaGam B®), and copegus/rebetol/ribasphere/vilona/virazole (commercially available as Ribavirin®); herpes treatments, including valacyclovir hydrochloride (commercially available as Valtrex®), penciclovir (commercially available as Denavir®), acyclovir (commercially available as Zovirax®), and famciclovir (commercially available as Famvir®); treatment for high blood pressure, including enalaprilat (available as Vasotec®), captopril (available as Capoten®) and lisinopril (available as Zestril®), verapamil hydrochloride (available as Calan®), ramipril (commercially available as Altace®), olmesartan medoxomil (commercially available as Ben
  • the films of the present disclosure may include actives useful in the medication for the treatment of HIV/AIDS, such as amprenavir (commercially available as Agenerase®), tipranavir (commercially available as Aptivus®), efavirenz/emtricitabine/tenofovir (commercially available as Atripla®), lamivudine/zidovudine (commercially available as Combivir®), indinavir sulfate (commercially available as Crixivan®), lamivudine (commercially available as Epivir®), saquinavir (commercially available as Fortovase®), zalcitabine (commercially available as Hivid®), lopinavir/ritonavir (commercially available as Kaletra®), fosamprenavir calcium (commercially available as Lexiva®), ritonavir (commercially available as Norvir®), zidovudine (commercially available as Retrovir®), atazanavir sulfate (commercially available as Rey
  • Actives useful in the present disclosure may further include prolactin inhibitors, such as bromocriptine mesylate (commercially available as Parlodel®); medications for aiding in stress tests, such as regadenoson (commercially available as Lexiscan®); baldness medication, including finasteride (commercially available as Propecia® and Proscar®); pancreatitis treatment, such as gemfibrozil (commercially available as Lopid®); hormone medications, such as norethindrone acetate/ethinyl estradiol (commercially available as femHRT®), goserelin acetate (commercially available as Zoladex®), progesterone gel (commercially available as Prochieve®), progesterone (commercially available as Prometrium®), calcitonin-salmon (commercially available as Miacalcin®), calcitriol (commercially available as Rocaltrol®), synthroid (commercially available as Levothroid®, Levoxyl®, Unithroid®
  • Actives useful herein may also include osteoporosis medications, including ibrandronate sodium (commercially available as Boniva®), risedronate (commercially available as Actonel®), raloxifene hydrochloride (commercially available as Evista®, Fortical®), and alendronate sodium (commercially available as Fosamax®); ovulation enhancers, including clomiphene citrate (commercially available as Serophene®, Clomid®, Serophene®); Paget’s disease treatment, such as etidronate disodium (commercially available as Didronel®); pancreatic enzyme deficiency medications, such as pancrelipase (commercially available as Pancrease® or Zenpep®); medication for the treatment of Parkinson’s disease, such as pramipexole dihydrochloride (commercially available as Mirapex®), ropinirole hydrochloride (commercially available as Requip®), carbidopa/levodopa (commercially available as Sine
  • Films of the present disclosure may further include psychiatric medications, including alprazolam (available as Niravam®, Xanax®), clozopin (available as Clozaril®), haloperidol (available as Haldol®), fluoxetine hydrochloride (available as Prozac®), sertraline hydrochloride (available as Zoloft®), asenapine (commercially available as Saphris®), iloperidone (commercially available as Fanapt®), paroxtine hydrochloride (available as Paxil®), aripiprazole (commercially available as Abilify®), guanfacine (commercially available as Intuniv®), Amphetamines and methamphetamines (commercially available as Adderall® and Desoxyn®), clomipramine hydrochloride (commercially available as Anafranil®), Buspirone hydrochloride (commercially available as BuSpar®), citalopram hydrobromide (commercially available as Celex
  • Actives useful herein may also include uric acid reduction treatment, including allopurinol (commercially available as Zyloprim®); seizure medications, including gabapentin (commercially available as Neurontin®), ethotoin (commercially available as Peganone®), vigabatrin (commercially available as Sabril®), and topiramate (commercially available as Topamax®); treatment for shingles, such as zoster vaccine live (commercially available as Zostavax®); skin care medications, including calcipotriene (commercially available as Dovonex®), ustekinumab (commercially available as Stelara®), televancin (commercially available as Vibativ®), isotretinoin (commercially available as Accutane®), hydrocortisone/iodoquinol (commercially available as Alcortin ®), sulfacetamide sodium/sulfur (commercially available as Avar®), azelaic acid (commercially available as Azelex®, Fin
  • Other actives useful herein may include Sleep disorder medications, including zaleplon (available as Sonata®), eszopiclone (available as Lunesta®), zolpidem tartrate (commercially available as Ambien®, Ambien CR®, Edluar®), lorazepam (commercially available as Ativan®), flurazepam hydrochloride (commercially available as Dalmane®), triazolam (commercially available as Halcion®), clonazepam (commercially available as Klonopin®), barbituates, such as Phenobarbital®), Modafinil (commercially available as Provigil®), temazepam (commercially available as Restoril®), ramelteon (commercially available as Rozerem®), clorazepate dipotassium (commercially available as Tranxene®), diazepam (commercially available as Valium®), quazepam (commercially available as Doral®), and estazolam (commercially available as Pro
  • Films of the present invention may further include actives useful for thyroid disease treatment, such as hormones TC and TD (commercially available as Armour Thyroid®); potassium deficiency treatment, including potassium chloride (commercially available as Micro- K®); triglycerides regulators, including omega-3-acid ethyl esters (commercially available as Omacor®); urinary medication, such as phenazopyridine hydrochloride (commercially available as Pyridium®) and methenamine, methylene blue/phenyl salicylate/benzoic acid/atropine sulfate/hyoscyamine (commercially available as Urised®); prenatal vitamins (commercially available as Advanced Natalcare®, Materna®, Natalins®, Prenate Advance®); weight control medication, including orlistat (commercially available as Xenical®) and sibutramine hydrochloride (commercially available as Meridia®).
  • actives useful for thyroid disease treatment such as hormones TC and TD (commercially available as Arm
  • H2- antagonists which are contemplated for use herein include cimetidine, ranitidine hydrochloride, famotidine, nizatidien, ebrotidine, mifentidine, roxatidine, pisatidine and aceroxatidine.
  • Active antacid ingredients include, but are not limited to, the following: aluminum hydroxide, dihydroxyaluminum aminoacetate, aminoacetic acid, aluminum phosphate, dihydroxyaluminum sodium carbonate, bicarbonate, bismuth aluminate, bismuth carbonate, bismuth subcarbonate, bismuth subgallate, bismuth subnitrate, bismuth subsilysilate, calcium carbonate, calcium phosphate, citrate ion (acid or salt), amino acetic acid, hydrate magnesium aluminate sulfate, magaldrate, magnesium aluminosilicate, magnesium carbonate, magnesium glycinate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, milk solids, aluminum mono-ordibasic calcium phosphate, tricalcium phosphate, potassium bicarbonate, sodium tartrate, sodium bicarbonate, magnesium aluminosilicates, tartaric acids and salts.
  • the active agents employed in the present invention may include allergens or antigens, such as, but not limited to, plant pollens from grasses, trees, or ragweed; animal danders, which are tiny scales shed from the skin and hair of cats and other furred animals; insects, such as house dust mites, bees, and wasps; and drugs, such as penicillin.
  • allergens or antigens such as, but not limited to, plant pollens from grasses, trees, or ragweed
  • animal danders which are tiny scales shed from the skin and hair of cats and other furred animals
  • insects such as house dust mites, bees, and wasps
  • drugs such as penicillin.
  • Examples of specific actives include but are not limited to 16-alpha fluorocstradiol, 16- alpha-gitoxin, 16-epiestriol, 17 alpha dihydroequilenin, 17 alpha estradiol, 17 beta estradiol, 17 hydroxy progesterone, lalpha-hydroxyvitamin D2,l-dodecpyrrolidinone, 20-epi-l,25 dihydroxyvitamin D3, 22-oxacalcitriol, 2CVV, 2'-nor-cGMP, 3-isobutyl GABA, 5-ethynyluracil, 6-FUDCA, 7-methoxytacrine, Abamectin, abanoquil, abecarnil, abiraterone, Ablukast, Ablukast Sodium, Acadesine, acamprosate, Acarbose, Acebutolol, Acecainide Hydrochloride, Aceclidine, aceclofena
  • Another pharmaceutical active acceptable for use herein is lumateperone, as disclosed in U.S. Patent Nos. 9745300, 9708322, 7183282, 7071186, 6552017, 8648077, 8598119, 9751883, 9371324, 9315504, 9428506, 8993572, 8309722, 6713471, 8779139, 9168258, RE039680E1, 9616061, 9586960, and in U.S. Patent Publication Nos. 2017114037, 2017183350, 2015072964, 2004034015, 2017189398, 2016310502, 2015080404, the aforementioned contents of which are incorporated by reference herein in their entirety.
  • antidiabetic actives include but not limited to JTT-501 (PNU- 182716) (Reglitazar), AR-H039242, MCC-555 (Netoglitazone), AR-H049020 Tesaglitazar), CS- 011 (CI-1037), GW-409544x, KRP-297, RG-12525, BM-15.2054, CLX-0940, CLX-0921, DRF- 2189, GW-1929, GW-9820, LR-90, LY-510929, NIP-221, NIP-223, JTP-20993, LY 29311 Na, FK 614, BMS 298585, R 483, TAK 559, DRF 2725 (Ragaglitazar), E-686398, E-168049, E- 805645, L-054852, Demethyl asteriquinone B 1 (L-783281), L-363586, KRP-297, P32/98, CRE- 16336 and E
  • Erectile dysfunction therapies useful herein include, but are not limited to, agents for facilitating blood flow to the penis, and for effecting autonomic nervous activities, such as increasing parasympathetic (cholinergic) and decreasing sympathetic (adrenersic) activities.
  • Useful actives for treatment of erectile dysfunction include, for example, but are not limited to, alprostadil, tadalafil, vardenafil, apomorphine, yohimbine hydrochloride, sildenafil citrate, and any combination thereof.
  • the active is tadalafil.
  • Actives or medications for the treatment of headaches and/or migraines may also be used herein.
  • specific actives include, but are not limited to, triptans, such as eletriptan, naratriptan, rizatriptan (rizatriptan benzoate), sumatriptan, and zolmitriptan.
  • the active is rizatriptan, optionally in combination with an NSAID.
  • the pharmaceutically active component can be a benzodiazepine such as diazepam, lorazepam, midazolam, clorazepate, temazepam, triazolam, clonazepam, flurazepam, oxazepam, chlordiazepoxide, estazolam, quazepam, or alprazolam.
  • a benzodiazepine such as diazepam, lorazepam, midazolam, clorazepate, temazepam, triazolam, clonazepam, flurazepam, oxazepam, chlordiazepoxide, estazolam, quazepam, or alprazolam.
  • the composition can include a polymeric matrix. Any desired polymeric matrix may be used, provided that it is orally dissolvable or erodible.
  • the dosage should have enough bioadhesion to not be easily removed and it should form a gel like structure when administered. They can be moderate-dissolving in the oral cavity and particularly suitable for delivery of pharmaceutically active components, although both fast release, delayed release, controlled release and sustained release compositions are also among the various embodiments contemplated.
  • the pharmaceutical composition film can include dendritic polymers which can include highly branched macromolecules with various structural architectures.
  • the dendritic polymers can include dendrimers, dendronised polymers (dendrigrafted polymers), linear dendritic hybrids, multi-arm star polymers, or hyperbranched polymers.
  • Hyperbranched polymers are highly branched polymers with imperfections in their structure. However, they can be synthesized in a single step reaction which can be an advantage over other dendritic structures and are therefore suitable for bulk volume applications. The properties of these polymers apart from their globular structure are the abundant functional groups, intramolecular cavities, low viscosity and high solubility. Dendritic polymers have been used in several drug delivery applications. See, e.g., Dendrimers as Drug Carriers: Applications in Different Routes of Drug Administration. J Pharm Sci, VOL. 97, 2008, 123-143, which is incorporated by reference herein.
  • the dendritic polymers can have internal cavities which can encapsulate drugs.
  • the steric hindrance caused by the highly dense polymer chains might prevent the crystallization of the drugs.
  • branched polymers can provide additional advantages in formulating crystallizable drugs in a polymer matrix.
  • Suitable dendritic polymers include poly(ether) based dendrons, dendrimers and hyperbranched polymers, poly(ester) based dendrons, dendrimers and hyperbranched polymers, poly(thioether) based dendrons, dendrimers and hyperbranched polymers, poly(amino acid) based dendrons dendrimers and hyperbranched polymers, poly(arylalkylene ether) based dendrons, dendrimers and hyperbranched polymers, poly(alkyleneimine) based dendrons, dendrimers and hyperbranched polymers, poly(amidoamine) based dendrons, dendrimers or hyperbranched polymers.
  • hyperbranched polymers include poly(amines)s, polycarbonates, poly(ether ketone)s, polyurethanes, polycarbosilanes, poly siloxanes, poly(ester amine)s, poly(sulfone amine)s, poly(urea urethane)s and polyether polyols such as polyglycerols.
  • a film can be produced by a combination of at least one polymer and a solvent, optionally including other components.
  • the solvent may be water, a polar organic solvent including, but not limited to, ethanol, isopropanol, acetone, or any combination thereof.
  • the solvent may be a non-polar organic solvent, such as methylene chloride.
  • the film may be prepared by utilizing a selected casting or deposition method and a controlled drying process. For example, the film may be prepared through a controlled drying processes, which include application of heat and/or radiation energy to the wet film matrix to form a visco-elastic structure, thereby controlling the uniformity of content of the film.
  • the controlled drying processes can include air alone, heat alone or heat and air together contacting the top of the film or bottom of the film or the substrate supporting the cast or deposited or extruded film or contacting more than one surface at the same time or at different times during the drying process.
  • Some of such processes are described in more detail in U.S. Patent No. 8,765,167 and U.S. Patent No. 8,652,378, which are incorporated by reference herein.
  • the films may be extruded as described in U.S. Patent Publication No. 2005/0037055 Al, which is incorporated by reference herein.
  • a polymer included in the films may be water-soluble, water-swellable, water-insoluble, or a combination of one or more either water-soluble, water-swellable or water-insoluble polymers.
  • the polymer may include cellulose, cellulose derivatives or gums.
  • useful water-soluble polymers include, but are not limited to, polyethylene oxide, pullulan, hydroxypropylmethyl cellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, polyvinyl pyrrolidone, carboxymethyl cellulose, polyvinyl alcohol, sodium alginate, polyethylene glycol, xanthan gum, tragancanth gum, guar gum, acacia gum, arabic gum, polyacrylic acid, methylmethacrylate copolymer, carboxyvinyl copolymers, starch, gelatin, and combinations thereof.
  • useful water-insoluble polymers include, but are not limited to, ethyl cellulose, hydroxypropyl ethyl cellulose, cellulose acetate phthalate, hydroxypropyl methyl cellulose phthalate and combinations thereof.
  • ethyl cellulose hydroxypropyl ethyl cellulose
  • cellulose acetate phthalate hydroxypropyl methyl cellulose phthalate
  • combinations thereof it may be desirable to incorporate a polymer that provides a high level of viscosity as compared to lower dosages.
  • water-soluble polymer and variants thereof refer to a polymer that is at least partially soluble in water, and desirably fully or predominantly soluble in water, or absorbs water. Polymers that absorb water are often referred to as being water- swellable polymers.
  • the materials useful with the present invention may be water-soluble or water- swellable at room temperature and other temperatures, such as temperatures exceeding room temperature. Moreover, the materials may be water-soluble or water-swellable at pressures less than atmospheric pressure. In some embodiments, films formed from such water-soluble polymers may be sufficiently water-soluble to be dissolvable upon contact with bodily fluids.
  • biodegradable polymers include materials that chemically degrade, as opposed to materials that physically break apart (i.e., bioerodable materials).
  • bioerodable materials include materials that chemically degrade, as opposed to materials that physically break apart (i.e., bioerodable materials).
  • the polymers incorporated in the films can also include a combination of biodegradable or bioerodable materials.
  • poly(glycolic acid) PGA
  • poly(lactic acid) PLA
  • polydioxanes polyoxalates
  • poly(alpha-esters) polyanhydrides
  • polyacetates polycaprolactones
  • poly(orthoesters) polyamino acids
  • polyaminocarbonates polyurethanes
  • polycarbonates polyamides
  • poly(alkyl cyanoacrylates) poly(alkyl cyanoacrylates)
  • Additional useful polymers include, stereopolymers of L- and D-lactic acid, copolymers of bis(p-carboxyphenoxy)propane acid and sebacic acid, sebacic acid copolymers, copolymers of caprolactone, poly(lactic acid)/poly(glycolic acid)/polyethyleneglycol copolymers, copolymers of polyurethane and (poly (lactic acid), copolymers of alpha- amino acids, copolymers of alpha-amino acids and caproic acid, copolymers of alpha-benzyl glutamate and polyethylene glycol, copolymers of succinate and poly(glycols), polyphosphazene, polyhydroxy-alkanoates or mixtures thereof.
  • the polymer matrix can include one, two, three, four or more components.
  • the time period for which it is desired to maintain the film in contact with the mucosal tissue depends on the type of pharmaceutically active component contained in the composition. Some pharmaceutically active components may only require a few minutes for delivery through the mucosal tissue, whereas other pharmaceutically active components may require up to several hours or even longer. Accordingly, in some embodiments, one or more water-soluble polymers, as described above, may be used to form the film.
  • water-soluble polymers and polymers that are water- swellable, water-insoluble and/or biodegradable may be desirable to use combinations of water-soluble polymers and polymers that are water- swellable, water-insoluble and/or biodegradable, as provided above.
  • the inclusion of one or more polymers that are water- swellable, water-insoluble and/or biodegradable may provide films with slower dissolution or disintegration rates than films formed from water-soluble polymers alone. As such, the film may adhere to the mucosal tissue for longer periods of time, such as up to several hours, which may be desirable for delivery of certain pharmaceutically active components.
  • an individual film dosage of the pharmaceutical film can have a suitable thickness, and small size, which is between about 0.0625-3 inch by about 0.0625-3 inch.
  • the film size can also be greater than 0.0625 inch, greater than 0.5 inch, greater than 1 inch, greater than 2 inches, about 3 inches, and greater than 3 inches, less than 3 inches, less than 2 inches, less than 1 inch, less than 0.5 inch, less than 0.0625 inch in at least one aspect, or greater than 0.0625 inch, greater than 0.5 inch, greater than 1 inch, greater than 2 inches, or greater than 3 inches, about 3 inches, less than 3 inches, less than 2 inches, less than 1 inch, less than 0.5 inch, less than 0.0625 inch in another aspect.
  • the aspect ratio including thickness, length, and width can be optimized by a person of ordinary skill in the art based on the chemical and physical properties of the polymeric matrix, the active pharmaceutical ingredient, dosage, enhancer, and other additives involved as well as the dimensions of the desired dispensing unit.
  • the film dosage should have good adhesion when placed in the buccal cavity or in the sublingual region of the user. Further, the film dosage should disperse and dissolve at a moderate rate, most desirably dispersing within about 1 minute and dissolving within about 3 minutes.
  • the film dosage may be capable of dispersing and dissolving at a rate of between about 1 to about 30 minutes, for example, about 1 to about 20 minutes, or more than 1 minute, more than 5 minutes, more than 7 minutes, more than 10 minutes, more than 12 minutes, more than 15 minutes, more than 20 minutes, more than 30 minutes, about 30 minutes, or less than 30 minutes, less than 20 minutes, less than 15 minutes, less than 12 minutes, less than 10 minutes, less than 7 minutes, less than 5 minutes, or less than 1 minute.
  • Sublingual dispersion rates may be shorter than buccal dispersion rates.
  • the films may include polyethylene oxide alone or in combination with a second polymer component.
  • the second polymer may be another water- soluble polymer, a water- swellable polymer, a water- insoluble polymer, a biodegradable polymer or any combination thereof.
  • Suitable water-soluble polymers include, without limitation, any of those provided above.
  • the water-soluble polymer may include hydrophilic cellulosic polymers, such as hydroxypropyl cellulose and/or hydroxypropylmethyl cellulose.
  • one or more water-swellable, waterinsoluble and/or biodegradable polymers also may be included in the polyethylene oxide-based film.
  • the second polymer component may be employed in amounts of about 0% to about 80% by weight in the polymer component, more specifically about 30% to about 70% by weight, and even more specifically about 40% to about 60% by weight, including greater than 5%, greater than 10%, greater than 15%, greater than 20%, greater than 30%, greater than 40%, greater than 50%, greater than 60%, and greater than 70%, about 70%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10% or less than 5% by weight.
  • Additives may be included in the films.
  • classes of additives include preservatives, antimicrobials, excipients, lubricants, buffering agents, stabilizers, blowing agents, pigments, coloring agents, fillers, bulking agents, sweetening agents, flavoring agents, fragrances, release modifiers, adjuvants, plasticizers, flow accelerators, mold release agents, polyols, granulating agents, diluents, binders, buffers, absorbents, glidants, adhesives, antiadherents, acidulants, softeners, resins, demulcents, solvents, surfactants, emulsifiers, elastomers, anti-tacking agents, anti-static agents and mixtures thereof.
  • additives may be added with the pharmaceutically active component(s).
  • stabilizer means an excipient capable of preventing aggregation or other physical degradation, as well as chemical degradation, of the active pharmaceutical ingredient, another excipient, or the combination thereof.
  • Stabilizers may also be classified as antioxidants, sequestrants, pH modifiers, emulsifiers and/or surfactants, or UV stabilizers.
  • Antioxidants include, in particular, the following substances: tocopherols and the esters thereof, sesamol of sesame oil, coniferyl benzoate of benzoin resin, nordihydroguaietic resin and nordihydroguaiaretic acid (NDGA), gallates (among others, methyl, ethyl, propyl, amyl, butyl, lauryl gallates), butylated hydroxyanisole (BHA/BHT, also butyl-p-cresol); ascorbic acid and salts and esters thereof (for example, acorbyl palmitate), erythorbinic acid (isoascorbinic acid) and salts and esters thereof, monothioglycerol, sodium formaldehyde sulfoxylate, sodium metabisulfite, sodium bisulfite, sodium sulfite,
  • Typical antioxidants are tocopherol such as, for example, a-tocopherol and the esters thereof, butylated hydroxytoluene and butylated hydroxyanisole.
  • tocopherol also includes esters of tocopherol.
  • a known tocopherol is a-tocopherol.
  • a-tocopherol includes esters of a-tocopherol (for example, a-tocopherol acetate).
  • a natural or synthetic tocopherol or tocotrienol can include alpha-tocopherol, beta-tocopherol, gamma-tocopherol, delta-tocopherol, alpha-tocotrienol, beta-tocotrienol, gamma- tocotrienol, delta-tocotrienol, tocophersolan, any isomers thereof, any esters thereof, any analogs or derivatives thereof, and any combinations thereof.
  • the composition can include up to 85% (w/w) tocopherol or tocotrienol, for example, 45% to 75% (w/w).
  • Sequestrants i.e., any compounds which can engage in host-guest complex formation with another compound, such as the active ingredient or another excipient; also referred to as a sequestering agent
  • a sequestering agent include calcium chloride, calcium disodium ethylene diamine tetra-acetate, glucono delta-lactone, sodium gluconate, potassium gluconate, sodium tripolyphosphate, sodium hexametaphosphate, and combinations thereof.
  • Sequestrants also include cyclic oligosaccharides, such as cyclodextrins, cyclomannins (5 or more a-D-mannopyranose units linked at the 1,4 positions by a linkages), cyclogalactins (5 or more P-D-galactopyranose units linked at the 1,4 positions by P linkages), cycloaltrins (5 or more a-D-altropyranose units linked at the 1,4 positions by a linkages), and combinations thereof.
  • cyclic oligosaccharides such as cyclodextrins, cyclomannins (5 or more a-D-mannopyranose units linked at the 1,4 positions by a linkages), cyclogalactins (5 or more P-D-galactopyranose units linked at the 1,4 positions by P linkages), cycloaltrins (5 or more a-D-altropyranose units linked at the 1,4 positions by a linkages), and combinations thereof
  • pH modifiers or stabilizers include acids (e.g., tartaric acid, citric acid, lactic acid, fumaric acid, phosphoric acid, ascorbic acid, acetic acid, succinic acid, adipic acid and maleic acid), acidic amino acids (e.g., glutamic acid, aspartic acid, etc.), inorganic salts (alkali metal salt, alkaline earth metal salt, ammonium salt, etc.) of such acidic substances, a salt of such acidic substance with an organic base (e.g., basic amino acid such as lysine, arginine and the like, meglumine and the like), and a solvate (e.g., hydrate) thereof.
  • acids e.g., tartaric acid, citric acid, lactic acid, fumaric acid, phosphoric acid, ascorbic acid, acetic acid, succinic acid, adipic acid and maleic acid
  • acidic amino acids e.g., glutamic acid, aspart
  • pH modifiers include silicified microcrystalline cellulose, magnesium aluminometasilicate, calcium salts of phosphoric acid (e.g., calcium hydrogen phosphate anhydrous or hydrate, calcium, sodium or potassium carbonate or hydrogencarbonate and calcium lactate or mixtures thereof), sodium and/or calcium salts of carboxymethyl cellulose, cross-linked carboxymethylcellulose (e.g., croscarmellose sodium and/or calcium), polacrilin potassium, sodium and or/calcium alginate, docusate sodium, magnesium calcium, aluminium or zinc stearate, magnesium palmitate and magnesium oleate, sodium stearyl fumarate, and combinations thereof.
  • phosphoric acid e.g., calcium hydrogen phosphate anhydrous or hydrate, calcium, sodium or potassium carbonate or hydrogencarbonate and calcium lactate or mixtures thereof
  • carboxymethyl cellulose e.g., croscarmellose sodium and/or calcium
  • polacrilin potassium sodium and or/calcium alginate
  • emulsifiers and/or surfactants include poloxamers or pluronics, polyethylene glycols, polyethylene glycol monostearate, polysorbates, sodium lauryl sulfate, polyethoxylated and hydrogenated castor oil, alkyl polyoside, a grafted water soluble protein on a hydrophobic backbone, lecithin, glyceryl monostearate, glyceryl mono stearate/polyoxy ethylene stearate, ketostearyl alcohol/sodium lauryl sulfate, carbomer, phospholipids, (Cio-C2o)-alkyl and alkylene carboxylates, alkyl ether carboxylates, fatty alcohol sulfates, fatty alcohol ether sulfates, alkylamide sulfates and sulfonates, fatty acid alkylamide polyglycol ether sulfates, alkanesulfonates and hydroxyal
  • UV stabilizers examples include UV absorbers (e.g., benzophenones), UV quenchers (i.e., any compound that dissipates UV energy as heat, rather than allowing the energy to have a degradation effect), scavengers (i.e., any compound that eliminates free radicals resulting from exposure to UV radiation), and combinations thereof.
  • UV absorbers e.g., benzophenones
  • UV quenchers i.e., any compound that dissipates UV energy as heat, rather than allowing the energy to have a degradation effect
  • scavengers i.e., any compound that eliminates free radicals resulting from exposure to UV radiation
  • stabilizers include ascorbyl palmitate, ascorbic acid, alpha tocopherol, butylated hydroxytoluene, buthylated hydroxyanisole, cysteine HC1, citric acid, ethylenediamine tetra acetic acid (EDTA), methionine, sodium citrate, sodium ascorbate, sodium thiosulfate, sodium metabi sulfite, sodium bisulfite, propyl gallate, glutathione, thioglycerol, singlet oxygen quenchers, hydroxyl radical scavengers, hydroperoxide removing agents, reducing agents, metal chelators, detergents, chaotropes, and combinations thereof.
  • EDTA ethylenediamine tetra acetic acid
  • “Singlet oxygen quenchers” include, but are not limited to, alkyl imidazoles (e.g., histidine, L-camosine, histamine, imidazole 4-acetic acid), indoles (e.g., tryptophan and derivatives thereof, such as N- acetyl-5-methoxytryptamine, N-acetylserotonin, 6-methoxy-l,2,3,4-tetrahydro-beta-carboline), sulfur-containing amino acids (e.g., methionine, ethionine, djenkolic acid, lanthionine, N-formyl methionine, felinine, S-allyl cysteine, S-aminoethyl-L-cysteine), phenolic compounds (e.g., tyrosine and derivatives thereof), aromatic acids (e.g., ascorbate, salicylic acid, and derivatives thereof), azide (e.g., sodium
  • “Hydroxyl radical scavengers” include, but are not limited to azide, dimethyl sulfoxide, histidine, mannitol, sucrose, glucose, salicylate, and L-cysteine.
  • “Hydroperoxide removing agents” include, but are not limited to catalase, pyruvate, glutathione, and glutathione peroxidases.
  • “Reducing agents” include, but are not limited to, cysteine and mercaptoethylene.
  • “Metal chelators” include, but are not limited to, EDTA, EGTA, o- phenanthroline, and citrate.
  • “Detergents” include, but are not limited to, SDS and sodium lauroyl sarcosyl.
  • Chaotropes include, but are not limited to guandinium hydrochloride, isothiocyanate, urea, and formamide.
  • stabilizers can be present in 0.0001%-50% by weight, including greater than 0.0001%, greater than 0.001%, greater than 0.01%, greater than 0.1%, greater than 1%, greater than 5%, greater than 10%, greater than 20%, greater than 30%, greater than 40%, greater than 50%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 1%, less than 0.1%, less than 0.01%, less than 0.001%, or less than 0.0001% by weight.
  • Useful additives can include, for example, gelatin, gelatin hydrosylates, recombinant gelatin, vegetable proteins such as sunflower protein, soybean proteins, cotton seed proteins, peanut proteins, grape seed proteins, whey proteins, whey protein isolates, blood proteins, egg proteins, acrylated proteins, water-soluble polysaccharides such as alginates, carrageenans, guar gum, agar-agar, xanthan gum, gellan gum, gum arabic and related gums (gum ghatti, gum karaya, gum tragancanth), pectin, water-soluble derivatives of cellulose: alkylcelluloses hydroxyalkylcelluloses and hydroxyalkylalkylcelluloses, such as methylcellulose, hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, hydroxyethylmethylcellulose, hydroxypropylmethylcellulose, hydroxybutylmethylcellulose, cellulose esters and hydroxyalkylcellulose esters such as cellulose acetate phthal
  • Stabilizers can include nanoparticulate stabilizers, such as a dispersant layer around a nanoparticulate surface. See, e.g., Langmuir 2007, (23)3, 1081-1090, December 20, 2006, doi.org/10.1021/la062042s.
  • Stabilizers can include stabilizer ligands, e.g., monomers bearing functional groups that can get chemisorbed on nanoparticles to form polymerizable monolayers. See, e.g., Jadhav et al doi.org/10.1002/ppsc.201400074.
  • Stabilizers can include surface stabilizers. See, e.g., U.S. Pat. No. 6428814 and Japanese Pat. JP 4598399B2.
  • Surface stabilizers can include tyloxapol (U.S. Pat. No. 5,429,824), polyalkylene block copolymers (U.S. Pat. No. 5,565,188), sulfated non-ionic block copolymers (U.S. Pat. No. 5,569,448), high molecular weight, linear, poly(ethylene oxide) polymers (U.S. Pat. No. 5,580,579), butylene oxide-ethylene oxide block copolymers (U.S. Pat. No. 5,587,143), hydroxypropyl cellulose (U.S. Pat. No. 5,591,456), and sugar based surface stabilizers (U.S. Pat. No. 5,622,938).
  • tyloxapol U.S. Pat. No. 5,429,824
  • polyalkylene block copolymers U.S. Pat. No. 5,565,188
  • sulfated non-ionic block copolymers U.S. Pat. No. 5,
  • Stabilizers can include peptide stabilizers. See, e.g., W02006097748A2. Stabilizers can include for example, L-cysteine hydrochloride, glycine hydrochloride, malic acid, sodium metabisulfite, citric acid, tartaric acid, and L-cystine dihydrochloride. See, e.g., U.S. Pat. 6,153,223. Stabilizers can include natural compounds. Stabilizers can include synthetic compounds. Stabilizers can include a blend of one of more compounds or categories of compounds described above. Stabilizers can be function to protect the metabolism of a prodrug until a desired time or until it reaches a specific target, tissue or environment.
  • the additional components can range up to about 80%, desirably about 0.005% to 50% and more desirably within the range of 1% to 20% based on the weight of all composition components, including greater than 1%, greater than 5%, greater than 10%, greater than 20%, greater than 30%, greater than 40%, greater than 50%, greater than 60%, greater than 70%, about 80%, greater than 80%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, about 3%, or less than 1%.
  • Other additives can include anti-tacking, flow agents and opacifiers, such as the oxides of magnesium aluminum, silicon, titanium, etc.
  • the composition can include plasticizers, which can include polyalkylene oxides, such as polyethylene glycols, polypropylene glycols, polyethylenepropylene glycols, organic plasticizers with low molecular weights, such as glycerol, glycerol monoacetate, diacetate or triacetate, triacetin, polysorbate, cetyl alcohol, propylene glycol, sugar alcohols sorbitol, sodium diethylsulfosuccinate, triethyl citrate, tributyl citrate, phytoextracts, fatty acid esters, fatty acids, oils and the like, added in concentrations ranging from about 0.1% to about 40%, and desirably ranging from about 0.5% to about 20% based on the weight of the composition including greater than 0.5%, greater than 1%, greater than 1.5%, greater than 2%, greater than 4%, greater than 5%, greater than 10%, greater than 15%, about 20%, greater than 20%, less than 20%, less than 15%, less
  • composition can further be added compounds to improve the texture properties of the film material such as animal or vegetable fats, desirably in their hydrogenated form.
  • the composition can also include compounds to improve the textural properties of the product.
  • Other ingredients can include binders which contribute to the ease of formation and general quality of the films.
  • binders include starches, natural gums, pregelatinized starches, gelatin, polyvinylpyrrolidone, methylcellulose, sodium carboxymethylcellulose, ethylcellulose, polyacrylamides, polyvinyloxoazolidone, or polyvinylalcohols .
  • Such agents include solubility enhancing agents, such as substances that form inclusion compounds with active components. Such agents may be useful in improving the properties of very insoluble and/or unstable actives.
  • these substances are doughnutshaped molecules with hydrophobic internal cavities and hydrophilic exteriors. Insoluble and/or instable pharmaceutically active components may fit within the hydrophobic cavity, thereby producing an inclusion complex, which is soluble in water. Accordingly, the formation of the inclusion complex permits very insoluble and/or unstable pharmaceutically active components to be dissolved in water.
  • a particularly desirable example of such agents are cyclodextrins, which are cyclic carbohydrates derived from starch. Other similar substances, however, are considered well within the scope of the present invention.
  • Suitable coloring agents include food, drug and cosmetic colors (FD&C), drug and cosmetic colors (D&C), or external drug and cosmetic colors (Ext. D&C). These colors are dyes, their corresponding lakes, and certain natural and derived colorants. Lakes are dyes absorbed on aluminum hydroxide. Other examples of coloring agents include known azo dyes, organic or inorganic pigments, or coloring agents of natural origin.
  • Inorganic pigments are preferred, such as the oxides or iron or titanium, these oxides, being added in concentrations ranging from about 0.001 to about 10%, and preferably about 0.5 to about 3%, including greater than 0.001%, greater than 0.01%, greater than 0.1%, greater than 0.5%, greater than 1%, greater than 2%, greater than 5%, about 10%, greater than 10%, less than 10%, less than 5%, less than 2%, less than 1%, less than 0.5%, less than 0.1%, less than 0.01%, or less than 0.001%, based on the weight of all the components.
  • Flavors may be chosen from natural and synthetic flavoring liquids.
  • An illustrative list of such agents includes volatile oils, synthetic flavor oils, flavoring aromatics, oils, liquids, oleoresins or extracts derived from plants, leaves, flowers, fruits, stems and combinations thereof.
  • a non-limiting representative list of examples includes mint oils, cocoa, and citrus oils such as lemon, orange, lime and grapefruit and fruit essences including apple, pear, peach, grape, strawberry, raspberry, cherry, plum, pineapple, apricot or other fruit flavors.
  • aldehydes and esters such as benzaldehyde (cherry, almond), citral i.e., alphacitral (lemon, lime), neral, i.e., beta-citral (lemon, lime), decanal (orange, lemon), aldehyde C-8 (citrus fruits), aldehyde C-9 (citrus fruits), aldehyde C-12 (citrus fruits), tolyl aldehyde (cherry, almond), 2,6-dimethyloctanol (green fruit), or 2-dodecenal (citrus, mandarin), combinations thereof and the like.
  • aldehydes and esters such as benzaldehyde (cherry, almond), citral i.e., alphacitral (lemon, lime), neral, i.e., beta-citral (lemon, lime), decanal (orange, lemon), aldehyde C-8 (citrus fruits), aldeh
  • the sweeteners may be chosen from the following non-limiting list: saccharides, glucose (corn syrup), dextrose, invert sugar, fructose, and combinations thereof, saccharin and its various salts such as the sodium salt; dipeptide based sweeteners such as aspartame, neotame, advantame; dihydrochalcone compounds, glycyrrhizin; Stevia Rebaudiana (Stevioside); chloro derivatives of sucrose such as sucralose; sugar alcohols such as sorbitol, mannitol, xylitol, and the like.
  • hydrogenated starch hydrolysates and the synthetic sweetener 3,6-dihydro-6-methyl-l-l-l,2,3-oxathiazin-4-one-2,2-dioxide particularly the potassium salt (acesulfame-K), and sodium and calcium salts thereof, and natural intensive sweeteners, such as Lo Han Kuo.
  • Other sweeteners may also be used.
  • Anti-foaming and/or de-foaming components may also be used with the films. These components aid in the removal of air, such as entrapped air, from the film-forming compositions. Such entrapped air may lead to non-uniform films.
  • Simethicone is one particularly useful antifoaming and/or de-foaming agent.
  • the present invention is not so limited and other suitable anti-foam and/or de-foaming agents may be used.
  • Simethicone and related agents may be employed for densification purposes. More specifically, such agents may facilitate the removal of voids, air, moisture, and similar undesired components, thereby providing denser and thus more uniform films. Agents or components which perform this function can be referred to as densification or densifying agents. As described above, entrapped air or undesired components may lead to non-uniform films.
  • the film compositions further desirably contain a buffer so as to control the pH of the film composition.
  • a buffer so as to control the pH of the film composition.
  • Any desired level of buffer may be incorporated into the film composition so as to provide the desired pH level encountered as the pharmaceutically active component is released from the composition.
  • the buffer is preferably provided in an amount sufficient to control the release from the film and/or the absorption into the body of the pharmaceutically active component.
  • the buffer may include sodium citrate, citric acid, bitartrate salt and combinations thereof.
  • the film dosage composition is formed by first preparing a wet composition, the wet composition including a polymeric carrier matrix and a therapeutically effective amount of a pharmaceutically active component.
  • the wet composition is cast into a film and then sufficiently dried to form a self-supporting film composition.
  • the wet composition may be cast into individual dosages, or it may be cast into a sheet, where the sheet is then cut into individual dosages.
  • the pharmaceutical composition can adhere to a mucosal surface.
  • the present invention finds particular use in the localized treatment of body tissues, diseases, or wounds which may have moist surfaces and which are susceptible to bodily fluids, such as the mouth, the vagina, organs, or other types of mucosal surfaces.
  • the composition carries a pharmaceutical, and upon application and adherence to the mucosal surface, offers a layer of protection and delivers the pharmaceutical to the treatment site, the surrounding tissues, and other bodily fluids.
  • the composition provides an appropriate residence time for effective drug delivery at the treatment site, given the control of erosion in aqueous solution or bodily fluids such as saliva, and the slow, natural erosion of the film concomitant or subsequent to the delivery.
  • the residence time of the composition depends on the erosion rate of the water erodible polymers used in the formulation and their respective concentrations.
  • the erosion rate may be adjusted, for example, by mixing together components with different solubility characteristics or chemically different polymers, such as hydroxyethyl cellulose and hydroxypropyl cellulose; by using different molecular weight grades of the same polymer, such as mixing low and medium molecular weight hydroxyethyl cellulose; by using excipients or plasticizers of various lipophilic values or water solubility characteristics (including essentially insoluble components); by using water soluble organic and inorganic salts; by using crosslinking agents such as glyoxal with polymers such as hydroxyethyl cellulose for partial crosslinking; or by post-treatment irradiation or curing, which may alter the physical state of the film, including its crystallinity or phase transition, once obtained.
  • the pharmaceutical composition film adheres to the mucosal surface and is held in place. Water absorption softens the composition, thereby diminishing the foreign body sensation.
  • delivery of the drug occurs. Residence times may be adjusted over a wide range depending upon the desired timing of the delivery of the chosen pharmaceutical and the desired lifespan of the carrier. Generally, however, the residence time is modulated between about a few seconds to about a few days. Preferably, the residence time for most pharmaceuticals is adjusted from about 5 seconds to about 24 hours. More preferably, the residence time is adjusted from about 5 seconds to about 30 minutes.
  • the composition adheres to the mucosal surface, it also provides protection to the treatment site, acting as an erodible bandage. Lipophilic agents can be designed to slow down erodibility to decrease disintegration and dissolution.
  • excipients which are sensitive to enzymes such as amylase, very soluble in water such as water soluble organic and inorganic salts.
  • Suitable excipients may include the sodium and potassium salts of chloride, carbonate, bicarbonate, citrate, trifluoroacetate, benzoate, phosphate, fluoride, sulfate, or tartrate.
  • the amount added can vary depending upon how much the erosion kinetics is to be altered as well as the amount and nature of the other components in the composition.
  • Emulsifiers typically used in the water-based emulsions described above are, preferably, either obtained in situ if selected from the linoleic, palmitic, myristoleic, lauric, stearic, cetoleic or oleic acids and sodium or potassium hydroxide, or selected from the laurate, palmitate, stearate, or oleate esters of sorbitol and sorbitol anhydrides, polyoxyethylene derivatives including monooleate, monostearate, monopalmitate, monolaurate, fatty alcohols, alkyl phenols, allyl ethers, alkyl aryl ethers, sorbitan monostearate, sorbitan monooleate and/or sorbitan monopalmitate.
  • the amount of pharmaceutically active component to be used depends on the desired treatment strength and the composition of the layers, although preferably, the pharmaceutical component comprises from about 0.001% to about 99%, more preferably from about 0.003 to about 75%, and most preferably from about 0.005% to about 50% by weight of the composition, including, more than 0.005%, more than 0.05%, more than 0.5%, more than 1%, more than 5%, more than 10%, more than 15%, more than 20%, more than 30%, about 50%, more than 50%, less than 50%, less than 30%, less than 20%, less than 15%, less than 10%, less than 5%, less than 1%, less than 0.5%, less than 0.05%, or less than 0.005%.
  • the amounts of other components may vary depending on the drug or other components but typically these components comprise no more than 50%, preferably no more than 30%, and most preferably no more than 15% by total weight of the composition.
  • the thickness of the film may vary, depending on the thickness of each of the layers and the number of layers. As stated above, both the thickness and amount of layers may be adjusted in order to vary the erosion kinetics.
  • the thickness ranges from 0.005 mm to 2 mm, preferably from 0.01 to 1 mm, and more preferably from 0.1 to 0.5 mm, including greater than 0.1 mm, greater than 0.2 mm, about 0.5 mm, greater than 0.5 mm, less than 0.5 mm, less than 0.2 mm, or less than 0.1 mm.
  • the thickness of each layer may vary from 10 to 90% of the overall thickness of the layered composition, and preferably varies from 30 to 60%, including greater than 10%, greater than 20%, greater than 30%, greater than 40%, greater than 50%, greater than 70%, greater than 90%, about 90%, less than 90%, less than 70%, less than 50%, less than 40%, less than 30%, less than 20%, or less than 10%.
  • the preferred thickness of each layer may vary from 0.01 mm to 0.9 mm, or from 0.03 to 0.5 mm.
  • the treatment site may include any area in which the film is capable of delivery and/or maintaining a desired level of pharmaceutical in the blood, lymph, or other bodily fluid.
  • such treatment sites include the oral, esophageal, aural, ocular, anal, nasal, or vaginal mucosal tissue, as well as, the skin. If the skin is to be employed as the treatment site, then usually larger areas of the skin wherein movement will not disrupt the adhesion of the film, such as the upper arm or thigh, are preferred.
  • the pharmaceutical composition can also be used as a wound dressing.
  • the film can not only protect a wound but also deliver a pharmaceutical in order to promote healing, aseptic, scarification, to ease the pain or to improve globally the condition of the sufferer.
  • Some of the: examples given below are well suited for an application to the skin or a wound.
  • the formulation might require incorporating a specific hydrophilic/hygroscopic excipient which would help in maintaining good adhesion on dry skin over an extended period of time.
  • Another advantage of the present invention when utilized in this manner is that if one does not wish that the film be noticeable on the skin, then no dyes or colored substances need be used. If, on the other hand, one desires that the film be noticeable, a dye or colored substance may be employed.
  • the pharmaceutical composition can adhere to mucosal tissues, which are wet tissues by nature, it can also be used on other surfaces such as skin or wounds.
  • the pharmaceutical film can adhere to the skin if prior to application the skin is wet with an aqueousbased fluid such as water, saliva, wound drainage or perspiration. The film can adhere to the skin until it erodes due to contact with water by, for example, rinsing, showering, bathing or washing.
  • the film may also be readily removed by peeling without significant damage to tissue.
  • the proposed dosing regimen for diazepam buccal film was designed to provide diazepam exposure in patients equivalent to the exposure achieved when the reference drug, Diastat Rectal Gel (DRG), which is administered according to its approved product label (Table 1 below).
  • the Diastat label provides a weight-adjusted dosing regimen that categorizes patients first according to three age groups: 2-5 years, 6-11 years, and 12+ years.
  • the recommended dose on mg/kg basis is approximately 0.5 mg/kg, 0.3 mg/kg, and 0.2 mg/kg for the three age groups, respectively. Within each age group, the recommended dose for an individual patient is determined based on 7 weight categories.
  • Cmax for DBF was reduced on average by approximately 33% following a moderate fat meal, and on average approximately 45% following a high-fat meal with no effect on AUC. It was assumed that DRG, because of its rectal administration, was not subject to a significant food effect.
  • the approved label for DRG (Diastat rectal gel) does not report a food effect study and no information pertinent to any effect of food is provided in the Diastat label.
  • the dose proportionality of DBF was formally investigated in a crossover study in healthy volunteers at doses of 5mg, lOmg and 15mg. A 15mg dose was included as the top dose in the proportionality study to establish linearity and provide flexibility as a potential titration dose. This study demonstrated dose-proportionality for both Cmax and AUC as shown in Figure 1A and Figure 1 B.
  • the two-arm food effect study showed that a high fat meal taken within 30 minutes of administration reduced Cmax on average by approximately 45% with no effect on AUC.
  • the four- arm study showed that position (whether upright or reclining) had no effect on diazepam PK.
  • Per the Valium label Diazepam, taken orally has a reduction in exposure following a moderate fat meal. A 20% reduction in Cmax, and a 27% reduction in AUC was reported along with an up to 2.5 hr shift in Tmax. Accordingly, when conducting the food effect study for DBF, it was anticipated that the portion of the drug swallowed, would then be subject to a food effect as well. However, surprisingly, the study showed that the unique attributes of the formulation resulted in a different food effect when compared to oral Valium. Following the administration of a high fat meal, DBF demonstrated a food effect that had a 47% reduction in Cmax, but no reduction in AUC. This was clearly unexpected and significantly greater than what was reported in the literature for Cmax associated with oral Valium, while differing from what was reported in the literature for AUC for oral Valium.
  • DBF DBF was administered with the subjects sitting upright with the film applied to the buccal mucosa for a period of 5 min. At this time, they swallowed any remaining drug product.
  • DBF was administered with the subject reclining on his or her side with the film placed the film on the lower buccal mucosa (such that all saliva pooled to the sight of administration). With subjects in this reclining position, DBF was administered in crossover fashion under conditions of fasting, a moderate fat meal, and high fat meal. The time that subjects were requested to swallow was increased from 5 min to 15 min to increase residence time.
  • DBF Pharmacokinetic (PK) studies in healthy volunteers demonstrated that DBF was not bioequivalent to DRG.
  • DBF differed from DRG in the following respects (1) DBF exhibited higher bioavailability than DRG; (2) The PK behavior of DBF was linear. Specifically, for DBF both Cmax and AUC increased in proportion to the dose. In contrast, the PK behavior of DRG was not linear. Specifically, for DRG, Cmax increased with dose to a degree that was less than dose-proportional, whereas AUC increased in proportion to the dose. (3) DBF exhibited a food effect (-45% reduction on average in Cmax after a high fat meal and -33% reduction on average after a moderate fat meal with no change in AUC). In contrast, it is assumed that DRG, because of its rectal route of administration, is not affected by food.
  • Aquestive used population PK modeling to select a dosing regimen to compensate for the differences in PK between DBF and DRG (Table 4).
  • the recommended DBF dose corresponding to each adult weight class as defined in the Diastat rectal gel label was selected (1) to provide a dose sufficiently high to ensure that the predicted median of the resulting diazepam Cmax following a moderate fat meal was similar to the median Cmax following the labeled dose of Diastat rectal gel, and (2) to provide a dose for which the predicted median of the resulting diazepam Cmax under fasting conditions would not exceed the median Cmax values observed and demonstrated as safe in Phase 1 healthy volunteer studies with DBF.
  • Simulations based on population PK modeling demonstrated that under conditions of a moderate fat meal, the proposed DBF dosing regimen produced for each weight class a Cmax similar to the Cmax expected following the labeled dose of Diastat rectal gel.
  • pharmacokinetic parameters were derived from a singledose, crossover study in which plasma samples for determination of diazepam concentrations were drawn at various times up to 4 h after administration of 12.5 mg DBF either when no seizure activity had been observed in the preceding 3 h (interictal) or within 5 min of a seizure (periictal).
  • the study subjects were 35 adult men and women ages 17-65 with poorly controlled tonic-clonic seizures or focal seizures with impaired awareness. Patients were excluded from analysis if both treatments were not completed (4 subjects), critical time points were missing (6 subjects), pre-dose diazepam concentrations were >5% of the subsequent Cmax (2 subjects), or DBF was administered in a manner contrary to instructions (5 subjects).
  • AUCo-4h area under the plasma concentration-time curve from 0 to 4 h after dosing; Cmax, maximum plasma drug concentration; T m ax, time to reach maximum plasma concentration. From Rogawski et al.
  • DBF was administered according to the proposed weight- adjusted dosing regimen in Table 4 and Diastat (DRG) was administered according to the dosing regimen for Diastat in the FDA-approved label.
  • patients could enroll in an optional third period to receive DBF after a high-fat meal.
  • a secondary objective of the study was to compare the PK performance of DBF administered after a high fat meal with Diastat (DRG) administered after a moderate fat meal. Results of the primary comparison are shown in the Table 7, below.
  • the ratio [DBF/DRG] of the Cmax values in this head-to-head study was 96.70% with 90% CI 70.53-132.58 % (Table 7 demonstrating successfully that the diazepam Cmax following a moderate fat meal was similar to the Cmax following the labeled dose of DRG (an outcome consistent with predictions from population PK modeling). This result serves to validate the proposed DBF dosing algorithm. Note also that the AUC values (ratio [DBF/DRG] of geometric means for AUC(O-inf) was greater than 100%, despite equal or lower mg doses for DBF, are also consistent with the results of population PK modelling indicating that DBF exhibits higher bioavailability than DRG.
  • Table 7 Pharmacokinetic Parameters Following DBF and DRG Administered to Adults with Epilepsy According to Body Weight Following a Moderate-Fat Meal
  • the proposed DBF dose regimen also performed well within each weight category and yielded Cmax values more consistent across the weight categories than those following administration of Diastat.
  • Results of the secondary comparison (the comparison of DBF following a high fat meal with DRG) are shown in Table 8.
  • the ratio [DBF (high-fat)/DRG] of the Cmax values (geometric means) was 82.67% with 90% CI 55.61-122.91 % . This ratio ( ⁇ 82.5%) was consistent with the value predicted by population PK modelling and also serves to validate the proposed DBF dosing algorithm.
  • Table 8 Pharmacokinetic Parameters Following DBF and DRG Administered to Adults with Epilepsy According to Body Weight Following a High-Fat Meal (DBF) and a Moderate Fat Meal (DRG)
  • Diazepam buccal film is a novel dosage form of diazepam under development for the management of patients with refractory epilepsy requiring intermittent use of diazepam to control increased seizure activity.
  • PK pharmacokinetic
  • Diazepam plasma samples were obtained pre-dose and at intervals until 10 d after dosing to enable analysis of maximal plasma concentration (Cmax), time to Cmax (T m ax), area under the curve to the last measurable concentration (AUCO-T), and AUC extrapolated to infinity (AUCO-INF). Subjects were monitored for adverse events (AE) throughout the study.
  • Cmax maximal plasma concentration
  • T m ax time to Cmax
  • AUCO-T area under the curve to the last measurable concentration
  • AUCO-INF AUC extrapolated to infinity
  • Cmax values for DBF and DRG were 204.26 ng/mL (geometric SD [GSD] 136.12-306.49) and 211.22 ng/mL (GSD 87.71-508.63), respectively (see Figure 7), indicating that Cmax values following DBF were comparable but significantly less variable than Cmax values following DRG (P ⁇ 0.0001). Values for AUC were higher for DBF than for DRG, and median T m ax values for DBF and DRG were 1.0 and 0.52 h, respectively (P ⁇ 0.05). Three of 28 subjects following DRG dosing failed to achieve a plasma concentration >70 ng/mL. There were no serious AEs related to study drug.
  • ARS acute repetitive seizures
  • ARS are commonly referred to as “seizure clusters” or “seizure flurries” .
  • ARS raise concerns for seizure-associated risks, including postictal psychosis, physical injury, negative social and economic impact from frequent emergency department visits, hospitalizations, or missed school or work days, and for status epilepticus that may lead to persistent neurological impairment or death (Refs. 1-7) .
  • Diazepam buccal film is a novel dosage form of diazepam under development for the management of patients with refractory epilepsy requiring intermittent use of diazepam to control increased seizure activity (Refs. 11, 12).
  • DBF consists of a rectangular of film smaller than the size of a postage stamp, which is affixed to the buccal mucosa inside the cheek.
  • Diazepam carried within the dissolving polymer matrix of the film is absorbed transmucosally and is also swallowed.
  • DRG diazepam rectal gel
  • Diastat® AcuDialTM rectal gel Valeant Pharmaceuticals, Bridgewater, NJ, USA
  • midazolam nasal spray Nayzilam® nasal spray, UCB Biopharma, Smyrna, GA, USA
  • Rectal administration can be difficult and time consuming, and is otherwise problematic for many patients and caregivers due to concerns regarding embarrassment and social acceptability (Refs. 13,17,18) Intranasal administration is often poorly accepted by patients, which can negatively impact compliance
  • PK Pharmacokinetic
  • DRG was dosed according to the weight-based regimen in the FDA-approved label (dose range 10-20 mg) and DBF was dosed according to a weight-based regimen (dose range 10-17.5 mg) predicted to approximate the PK performance of DRG with respect to Cmax (Table 10)
  • the treatments were administered following a moderate-fat meal.
  • a window of ⁇ 1 minute was allowed for blood samples obtained within the first 8 hours post-dose, ⁇ 3 minutes for samples obtained within 8 to 24 hours post-dose, and ⁇ 60 minutes for all subsequent blood samples.
  • PK parameters of interest included Cmax, time to Cmax (Tmax), AUC from time zero to the last non-zero concentration (AUC0-T), and AUC from time zero extrapolated to infinity (AUC0-INF).
  • the safety population included all patients who received at least one dose of study drug; the PK population included all patients who completed period 1 and period 2, had no significant violations of the study protocol, and for whom the PK profile could be adequately characterized.
  • PK data were summarized overall and for each weight category using descriptive statistics.
  • ANOVA was performed on log-transformed AUC0-T, AUC0-INF, and Cmax at alpha 0.05. Factors in the model were sequence, subject within sequence, period, and treatment. Tmax was analyzed using the non-parametric Wilcoxon signed-rank test.
  • the ratios of geometric means with 90% confidence intervals based on least-squares means from ANOVA of log-transformed data were calculated for Cmax, AUC0-T, and AUC0- INF for DBF versus DRG values for all subjects irrespective of weight category, and for subjects within each weight category.
  • PK profiles valid for analysis for both DBF and DRG were available for 28 subjects (13 males, 15 females; mean [SD] weight: 84.6 [20.6 kg]).
  • Diazepam mean (SD) doses were 15.4 (1.9) mg and 17.1 (3.0) mg for DBF and DRG, respectively.
  • AUC0-T and AUC0-INF values were higher for DBF than for DRG
  • AUC(O-INF) (ng*h/mL), 8672.09 6880.96 126.03 103.67, 153.21
  • Cmax values following DBF and DRG administration were 204.26 ng/mE (geometric SD [GSD]: 136.12-306.49) and 211.22 ng/mL (GSD 87.71-508.63), respectively, indicating that Cmax values following DBF were comparable but significantly less variable than Cmax values following DRG (P ⁇ 0.0001) (Table 11 and FIG. 7 inset).
  • the study utilized a high-fat meal composed of 2 eggs fried in butter, 2 strips of bacon, 8 oz / 200 mL of whole milk, 2 slices of toast with butter, and 4 oz / 2 hash brown potatoes.
  • the VALTOCO PK food effect crossover study consistently demonstrated a significant effect of a high fat meal on blood levels of diazepam following Valtoco by both (1) reducing the maximum diazepam plasma concentration by an average of 41% lower than that observed in the same subjects under fasting conditions and (2) consistently and substantially delaying the median time to maximum diazepam concentration from 2.5 hours under fasting conditions to 4 hours under fed conditions.
  • the existence of a food effect can be managed by adjusting the dosing regimen of a product to ensure that, under all fed or fasted conditions, patients receive sufficient plasma concentrations of drug within an acceptable timeframe and safety profile.

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Abstract

L'invention concerne une méthode d'administration de diazépam ayant un effet alimentaire.
PCT/US2022/047741 2021-10-25 2022-10-25 Compositions orales et nasales et méthodes de traitement Ceased WO2023076281A1 (fr)

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